Primary care led, FIT-based, triage of new onset colorectal symptoms and time to diagnosis of colorectal cancer

TY - JOUR

T1 - Primary care led, FIT-based, triage of new onset colorectal symptoms and time to diagnosis of colorectal cancer

AU - Atwal, Gurpreet Kaur

AU - Digby, Jayne

AU - Delson, Dwi

AU - Ward, Mark

AU - Nobes, Jenny

AU - Strachan, Judith

AU - Mowat, Craig

PY - 2023/6/18

Y1 - 2023/6/18

N2 - Introduction Symptoms alone are poor indicators of colorectal cancer (CRC) in patients presenting to primary care. NHS Tayside introduced FIT testing in primary care as an adjunct to clinical acumen in the assessment of new onset bowel symptoms in December 2015. We recently reported that this has been associated with an increase in non-emergency presentation of CRC but had no effect on stage at diagnosis. We aimed to assess whether primary care led, FIT-based triage influenced time to diagnosis of CRC. Methods NHS Tayside Cancer audit data from January 2016 to December 2019 was reviewed. This comprehensive data set included mode of presentation (e.g., primary care referral pathway, bowel screening, emergency), and date of diagnosis amongst other parameters. Patients with a diagnosis of CRC via the primary care referral pathway were identified and linkage was performed using their Community Health Index (CHI) number with the electronic patient record to determine whether patients had an associated FIT test and full blood count (FBC) at the point of referral. Time from referral to diagnosis of CRC was calculated for each patient and compared between the FIT and non-FIT groups. Results The study cohort consisted of 959 patients referred from primary care between January 2013-December 2019; 378 patients from the time period prior to the introduction of FIT into primary care and 581 patients referred after the introduction of FIT into primary care in December 2015. The median time to diagnosis for all patients before the introduction of FIT was 30 days (interquartile range [IQR] 16–57), whereas this was significantly reduced to 25 days (IQR 14–47) following the introduction of FIT (p=0.006). Following the introduction of FIT, 441 (75.9%) patients completed a FIT prior to referral and 140 (24.1%) did not. Those patients with a FIT result had a significantly faster time to diagnosis with a median result of 23 days (IQR 14–43) to diagnosis compared to 30 days (IQR 16–62) for patients without a FIT result (p=0.019). 97.3% of FIT patients had FBC results available to aid safety-netting of patients with low or undetectable faecal haemoglobin concentration. Conclusions FIT-based triage of patients with new bowel symptoms in primary care is associated with shorter time to diagnosis of CRC in this cohort.

AB - Introduction Symptoms alone are poor indicators of colorectal cancer (CRC) in patients presenting to primary care. NHS Tayside introduced FIT testing in primary care as an adjunct to clinical acumen in the assessment of new onset bowel symptoms in December 2015. We recently reported that this has been associated with an increase in non-emergency presentation of CRC but had no effect on stage at diagnosis. We aimed to assess whether primary care led, FIT-based triage influenced time to diagnosis of CRC. Methods NHS Tayside Cancer audit data from January 2016 to December 2019 was reviewed. This comprehensive data set included mode of presentation (e.g., primary care referral pathway, bowel screening, emergency), and date of diagnosis amongst other parameters. Patients with a diagnosis of CRC via the primary care referral pathway were identified and linkage was performed using their Community Health Index (CHI) number with the electronic patient record to determine whether patients had an associated FIT test and full blood count (FBC) at the point of referral. Time from referral to diagnosis of CRC was calculated for each patient and compared between the FIT and non-FIT groups. Results The study cohort consisted of 959 patients referred from primary care between January 2013-December 2019; 378 patients from the time period prior to the introduction of FIT into primary care and 581 patients referred after the introduction of FIT into primary care in December 2015. The median time to diagnosis for all patients before the introduction of FIT was 30 days (interquartile range [IQR] 16–57), whereas this was significantly reduced to 25 days (IQR 14–47) following the introduction of FIT (p=0.006). Following the introduction of FIT, 441 (75.9%) patients completed a FIT prior to referral and 140 (24.1%) did not. Those patients with a FIT result had a significantly faster time to diagnosis with a median result of 23 days (IQR 14–43) to diagnosis compared to 30 days (IQR 16–62) for patients without a FIT result (p=0.019). 97.3% of FIT patients had FBC results available to aid safety-netting of patients with low or undetectable faecal haemoglobin concentration. Conclusions FIT-based triage of patients with new bowel symptoms in primary care is associated with shorter time to diagnosis of CRC in this cohort.

UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pure_staging_and_production&SrcAuth=WosAPI&KeyUT=WOS:001053334700367&DestLinkType=FullRecord&DestApp=WOS_CPL

U2 - 10.1136/gutjnl-2023-BSG.367

DO - 10.1136/gutjnl-2023-BSG.367

M3 - Meeting abstract

SN - 0017-5749

VL - 72

SP - A208-A208

JO - Gut

JF - Gut

IS - SUPPL_2

M1 - P301

ER -