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Bailey JA, Morton AJ, Jones J, Chapman CJ, Oliver S, Morling JR, Patel H, Banerjea A, Humes DJ. Sociodemographic variations in the uptake of faecal immunochemical tests in primary care: a retrospective study. Br J Gen Pract 2023; 73:e843-e849. [PMID: 37845084 PMCID: PMC10587902 DOI: 10.3399/bjgp.2023.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/16/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Faecal immunochemical test (FIT) usage for symptomatic patients is increasing, but variations in use caused by sociodemographic factors are unknown. A clinical pathway for colorectal cancer (CRC) was introduced in primary care for symptomatic patients in November 2017. The pathway was commissioned to provide GPs with direct access to FITs. AIM To identify whether sociodemographic factors affect FIT return in symptomatic patients. DESIGN AND SETTING A retrospective study was undertaken in Nottingham, UK, following the introduction of FIT as triage tool in primary care. It was mandated for all colorectal referrals (except rectal bleeding or mass) to secondary care. FIT was used, alongside full blood count and ferritin, to stratify CRC risk. METHOD All referrals from November 2017 to December 2021 were retrospectively reviewed. Sociodemographic factors affecting FIT return were analysed by multivariate logistic regression. RESULTS A total of 35 289 (90.7%) patients returned their index FIT, while 3631 (9.3%) did not. On multivariate analysis, males were less likely to return an FIT (odds ratio [OR] 1.11, 95% confidence interval [CI] = 1.03 to 1.19). Patients aged ≥65 years were more likely to return an FIT (OR 0.78 for non-return, 95% CI = 0.72 to 0.83). Unreturned FIT more than doubled in the most compared with the least deprived quintile (OR 2.20, 95% CI = 1.99 to 2.43). Patients from Asian (OR 1.82, 95% CI = 1.58 to 2.10), Black (OR 1.21, 95% CI = 0.98 to 1.49), and mixed or other ethnic groups (OR 1.29, 95% CI = 1.05 to 1.59) were more likely to not return an FIT compared with patients from a White ethnic group. A total of 599 (1.5%) CRCs were detected; 561 in those who returned a first FIT request. CONCLUSION FIT return in those suspected of having CRC varied by sex, age, ethnic group, and socioeconomic deprivation. Strategies to mitigate effects on FIT return and CRC detection should be considered as FIT usage expands.
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Affiliation(s)
- James A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; School of Medicine, University of Nottingham, Nottingham
| | - Alastair J Morton
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; School of Medicine, University of Nottingham, Nottingham; National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham
| | - James Jones
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham
| | - Caroline J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham
| | - Simon Oliver
- Nottingham and Nottinghamshire Integrated Care Board, Nottingham
| | - Joanne R Morling
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham; School of Medicine, University of Nottingham, Nottingham
| | - Heetan Patel
- Nottingham and Nottinghamshire Integrated Care Board, Nottingham
| | - Ayan Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham
| | - David J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham
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Rahman F, Trivedy M, Rao C, Akinlade F, Mansuri A, Aggarwal A, Laskaratos FM, Rajendran N, Banerjee S. Faecal Immunochemical Testing to Detect Colorectal Cancer in Symptomatic Patients: A Diagnostic Accuracy Study. Diagnostics (Basel) 2023; 13:2332. [PMID: 37510076 PMCID: PMC10378039 DOI: 10.3390/diagnostics13142332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: NHS England recommended faecal immunochemical testing (FIT) for symptomatic patients in June 2020 to rationalise limited diagnostic services during COVID-19. (2) Aim: to investigate the diagnostic performance of FIT, analysing the proportion of FIT-negative colorectal cancers (CRC) missed in symptomatic patients and how this risk could be mitigated. (3) Design and Setting: a retrospective study of biochemistry and cancer databases involving patients referred from primary healthcare with suspected CRC to a single secondary care trust in North East London. (4) Methods: a retrospective cohort diagnostic accuracy study was undertaken to determine the performance of FIT for detecting CRC at 10 µgHb/g. (5) Results: between January and December 2020, 7653 patients provided a stool sample for FIT analysis; 1679 (22%) samples were excluded due to inadequate or incorrect specimens; 48% of suspected CRC referrals completed FIT before evaluation; 86 FIT tested patients were diagnosed with histologically proven CRC. At 10 µgHb/g, FIT performance was comparable with the existing literature with a sensitivity of 0.8140 (95% CI 0.7189-0.8821), a specificity of 0.7704 (95% CI 0.7595-0.7809), a positive predictive value (PPV) of 0.04923 (95% CI 0.03915-0.06174), a negative predictive value (NPV) of 0.9965 (95% CI 0.9943-0.9978), and a likelihood ratio (LR) of 3.545; 16 patients with CRC had an FIT of ≤10 µgHb/g (18.6% 95% CI 11.0-28.4%). (6) Conclusions: this study raises concerns about compliance with FIT testing and the incidence of FIT-negative CRC at the NICE recommended threshold and how this risk can be mitigated without colonic imaging. Whilst FIT may have facilitated prioritisation during COVID-19, we must be cautious about using FIT alone to determine which patients are referred to secondary care or receive further investigation.
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Affiliation(s)
- Farzana Rahman
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
| | - Mihir Trivedy
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
- Barts Health NHS Trust, Whipps Cross Hospital, London E11 1NR, UK
| | - Christopher Rao
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle CA2 7HY, UK
| | - Funmi Akinlade
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
| | - Ahmer Mansuri
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
| | - Atul Aggarwal
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
| | | | - Nirooshun Rajendran
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
| | - Saswata Banerjee
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford RM7 0A, UK
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Gil N, Su H, Kaur K, Barnett M, Murray A, Duffy S, von Wagner C, Kerrison RS. Patient experience and satisfaction with symptomatic faecal immunochemical testing: an explanatory sequential mixed-methods evaluation. Br J Gen Pract 2023; 73:e104-14. [PMID: 36702594 DOI: 10.3399/BJGP.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/06/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recent evidence suggests that faecal immunochemical testing (FIT) can rule out colorectal cancer (CRC) in symptomatic adults. To date, there has been little research exploring experiences of FIT for this population. AIM To explore patient experience and satisfaction with FIT in an 'early adopter' site in England. DESIGN Explanatory sequential mixed-methods approach combining mailed quantitative surveys with semi-structured telephone interviews. METHOD Multivariate logistic regression was used to analyse quantitative data. Thematic analysis was used to assess qualitative transcripts. RESULTS The survey had 260 responders, and it found that satisfaction with FIT was high (88.7%). Compared with test satisfaction, the proportion of responders satisfied with their GP consultation and how they received their results was lower (74.4% and 76.2%, respectively). Multivariate analysis showed that increased area-level deprivation and not receiving an explanation of the purpose of the test were associated with lower satisfaction with the GP consultation (both P-values <0.05), while increased area-level deprivation and not receiving results from the GP were associated with lower satisfaction with receiving results (both P-values <0.05). Interviews with responders (n = 20) helped explain the quantitative results. They revealed that 'not knowing the purpose of the test' caused 'anxiety' and 'confusion', which led to dissatisfaction. 'Not receiving results from GP' was considered 'unacceptable', as this left patients with a 'niggling doubt' and lack of diagnosis or assurance that they did not have cancer. CONCLUSION Patient satisfaction with symptomatic FIT is high. Efforts to improve satisfaction should focus on ensuring that patients understand the purpose of the test and always receive their test results.
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Ze Y, Tu H, Zhang L, Bai Y, Ren Y, Chen X, Xue Y, Sun R, Yang Y, Yang J, Zhou X, Liu L. A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening. J Multidiscip Healthc 2023; 16:571-586. [PMID: 36883167 PMCID: PMC9985980 DOI: 10.2147/jmdh.s398997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Objective To compare the screening efficacy of colonoscopy and pathologically confirmed single and combined Asia-Pacific colorectal screening (APCS), faecal immunochemical testing (FIT) and stool deoxyribonucleic acid (sDNA) testing protocols. Methods From April 2021 to April 2022, 842 volunteers participated in primary colorectal cancer (CRC) screenings using APCS scoring, FIT and sDNA testing and 115 underwent a colonoscopy. One hundred high-risk participants were then identified from the results of both processes. The differences in the three CRC screening tests in combination with the colonoscopy pathology diagnostics were evaluated using Cochran's Q test, the Dunn-Bonferroni test and area under the receiver operating characteristic curve (AUC) value analysis. Results Both FIT and sDNA testing demonstrated a 100% performance in detecting CRC. For advanced adenoma, the sensitivity of the FIT + sDNA test scheme (double positive) was 29.2%, and the sensitivities of the combined FIT + sDNA test and APCS scoring + sDNA test schemes were 62.5% and 95.8%, respectively. The FIT + sDNA testing kappa value of advanced colorectal neoplasia was 0.344 (p = 0.011). The sensitivity for nonadvanced adenoma of the APCS score + sDNA test scheme was 91.1%. In terms of positive results, the sensitivity of the APCS score + FIT + sDNA detection protocol was significantly higher than that of the APCS score, FIT, sDNA detection, and FIT + sDNA detection methods (adjusted p < 0.001, respectively). For the FIT + sDNA test, the kappa value was 0.220 (p = 0.015) and the AUC was 0.634 (p = 0.037). The specificity of the FIT + sDNA test scheme was 69.0%. Conclusion The FIT + sDNA test scheme demonstrated superior diagnostic efficacy, and the combined APCS score + FIT + sDNA test scheme demonstrated remarkable improvements in CRC screening efficiency and sensitivity for detecting positive lesions.
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Affiliation(s)
- Yuan Ze
- Wuxi School of Medicine, Jiangnan University, Wuxi, People's Republic of China
| | - Huiming Tu
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Lin Zhang
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China.,School of Population Medicine and Public Health, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital of Shanghai, Shanghai, People's Republic of China
| | - Yilin Ren
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Xin Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, People's Republic of China
| | - Yuzheng Xue
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Renjuan Sun
- Outpatient Nursing department, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Yuling Yang
- Nursing department of Geriatrics Ward, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Jie Yang
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Xuan Zhou
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Li Liu
- Data Center, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
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Botteri E, Hoff G, Randel KR, Holme Ø, de Lange T, Bernklev T, Aas E, Berthelsen M, Natvig E, Kirkøen B, Knudsen MD, Kvaerner AS, Schult AL, Ursin G, Jørgensen A, Berstad P. Characteristics of non-participants in a randomized colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing. Int J Cancer 2022; 151:361-371. [PMID: 35411554 PMCID: PMC9324830 DOI: 10.1002/ijc.34025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once‐only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty‐four thousand one hundred and fifty‐nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.
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Affiliation(s)
- Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, Skien, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin R Randel
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.,Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Medicine, Sahlgrenska University Hospital- Mölndal, Region Västra Götaland, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Medical Research, Baerum Hospital, Gjettum, Norway
| | - Tomm Bernklev
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Vestfold Hospital, Tønsberg, Norway
| | - Eline Aas
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Mona Berthelsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Erik Natvig
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Benedicte Kirkøen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Regional Center for Child and Adolescent Mental Health (RBUP), Oslo, Norway
| | - Markus D Knudsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Oslo, Norway.,Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ane S Kvaerner
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Anna L Schult
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Gjettum, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anita Jørgensen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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Maclean W, Zahoor Z, O'Driscoll S, Piggott C, Whyte MB, Rockall T, Jourdan I, Benton SC. Comparison of the QuikRead go ® point-of-care faecal immunochemical test for haemoglobin with the FOB Gold Wide ® laboratory analyser to diagnose colorectal cancer in symptomatic patients. Clin Chem Lab Med 2022; 60:101-108. [PMID: 34679264 DOI: 10.1515/cclm-2021-0655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Faecal immunochemical testing for haemoglobin (FIT) is used to triage patients for colonic investigations. Point-of-care (POC) FIT devices on the market have limited data for their diagnostic accuracy for colorectal cancer (CRC). Here, a POC FIT device is compared with a laboratory-based FIT system using patient collected samples from the urgent referral pathway for suspected CRC. METHODS A prospective, observational cohort study. Patients collected two samples from the same stool. These were measured by POC QuikRead go® (Aidian Oy, Espoo, Finland) and laboratory-based FOB Gold Wide® (Sentinel Diagnostics, Italy). Faecal haemoglobin <10 μg haemoglobin/g of faeces was considered as negative. At this threshold, comparisons between the two systems were made by calculating percentage agreement and Cohen's kappa coefficient. Proportion of negative results were compared with Chi squared testing. Sensitivities for CRC were calculated. RESULTS A total of 629 included patients provided paired samples for FIT to compare the QuikRead go® and FOB Gold Wide®. The agreement around the negative threshold was 83.0% and Cohen's kappa coefficient was 0.54. The QuikRead go® reported 440/629 (70.0% of samples) as negative compared to 523/629 (83.1%) for the FOB Gold Wide®, this difference was significant (p-value<0.001). Sensitivities for CRC detection by the QuikRead go® and FOB Gold Wide® were 92.9% (95% confidence interval (CI): 68.5-98.7%) and 100% (CI: 78.5-100%) respectively. CONCLUSIONS Both systems were accurate in their ability to detect CRC. Whilst good agreement around the negative threshold was identified, more patients would be triaged to further colonic investigation if using the QuikRead go®.
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Affiliation(s)
- William Maclean
- Research Fellow in General Surgery at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Zahida Zahoor
- Research Assistant at the Bowel Cancer Screening Hub at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Shane O'Driscoll
- Research Assistant at the Bowel Cancer Screening Hub at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Carolyn Piggott
- Research and Development Scientist at the Bowel Cancer Screening Hub at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Martin B Whyte
- Clinical Reader in Metabolic Medicine at University of Surrey, Guildford, UK
| | - Timothy Rockall
- Consultant Colorectal Surgeon at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Iain Jourdan
- Consultant Colorectal Surgeon at Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Sally C Benton
- Consultant Biochemist and Clinical Director at the Bowel Cancer Screening Hub at Royal Surrey NHS Foundation Trust, Guildford, UK
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Maclean W, Limb C, Mackenzie P, Whyte MB, Benton SC, Rockall T, Jourdan I. Adoption of faecal immunochemical testing for 2-week-wait colorectal patients during the COVID-19 pandemic: an observational cohort study reporting a new service at a regional centre. Colorectal Dis 2021; 23:1622-1629. [PMID: 33068489 DOI: 10.1111/codi.15408] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
AIM The COVID-19 pandemic has resulted in the near-complete loss of routine endoscopy services. We describe a major reorganization of service at a regional referral centre (Royal Surrey NHS Foundation Trust) to manage the crisis. Faecal immunochemical testing (FIT) was implemented for triage to make optimum use of limited diagnostic resources. Consultations were switched from face-to-face to telephone. Our aim was to evaluate the impact FIT had on resource allocation and patient diagnoses in the first 3 months of use. METHOD All colorectal 2-week-wait patient referrals were posted a pack requesting FIT and notification of telephone consultation. A prepaid envelope was included for return of the samples. At consultation, FIT was incorporated with the presenting symptoms to guide the choice of investigation and triage urgency. FIT ≥10 μg/g was interpreted as positive. Outcome data were collected prospectively and compared with retrospective audit data from prepandemic levels across 3 months. RESULTS From 26 March 2020 to 2 July 381 patients were referred who were invited to provide FIT samples and underwent telephone consultations. Three hundred and fifty eight FIT samples were returned (94%). Onward referral for colonoscopy reduced from 62% to 34% (P < 0.001). There were 14 colorectal cancers (CRC) (3.7%) diagnosed, which was not statistically different from the prepandemic level of 3.9% (P = 0.995). Twelve of the 14 patients with a CRC diagnosis had provided samples; all 12 had FIT ≥10 μg/g and were offered fast-track investigations. CONCLUSIONS The incorporation of FIT optimized the allocation of limited resources to triage those who required urgent colonic investigation for detecting CRC.
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Affiliation(s)
- William Maclean
- General Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Chris Limb
- General Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Paul Mackenzie
- General Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Sally C Benton
- Bowel Cancer Screening Hub, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Timothy Rockall
- General Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Iain Jourdan
- General Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
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Toes-Zoutendijk E, Portillo I, Hoeck S, de Brabander I, Perrin P, Dubois C, van Leerdam M, Lansdorp-Vogelaar I, Bardou M. Participation in faecal immunochemical testing-based colorectal cancer screening programmes in the northwest of Europe. J Med Screen 2019; 27:68-76. [PMID: 31645173 PMCID: PMC7222964 DOI: 10.1177/0969141319879712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective This study compared the participation in four faecal immunochemical testing-based screening programmes for colorectal cancer in Flanders, France, Basque country and the Netherlands, to identify factors to further optimize faecal immunochemical testing programmes. Method Background information and data on performance indicators were collected and compared for the four programmes. Results Invitation method, reminders, funding, faecal immunochemical testing cut-off and follow-up after positive faecal immunochemical testing differed in the four programmes. In France, only an invitation letter is sent by mail, while the sample kit must be collected from the general practitioner. In the other programmes, an invitation letter including the sample kit is sent by mail. Participation rates vary substantially according to the method of invitation, with the highest participation rates in the Netherlands (73.0%) and Basque country (72.4%), followed by Flanders (54.5%) and France (28.6%). Basque country (92.8%) and France (88.4%), the two programmes with most active involvement of general practitioners in referral for colonoscopy, had the highest participation rates for colonoscopy. Conclusions Large differences in screening participation observed between programmes according to the invitation method used suggest that changes to the design of the programme, such as including the sample kit with the invitation, or active involvement of GPs, might increase participation.
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Affiliation(s)
| | | | - Sarah Hoeck
- Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.,Centre for Cancer Detection, Brugge, Belgium
| | | | - Philippe Perrin
- Association pour le déspistage du Cancer Colorectal en Alsace (ADECA), Colmar, France
| | | | - Monique van Leerdam
- Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Marc Bardou
- Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Clinical Investigation Center INSERM 1432, Dijon-Bourgogne University Hospital, Dijon, France
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