Introduction of an integrated primary care faecal immunochemical test referral pathway for patients with suspected colorectal cancer symptoms

Aim To determine the efficacy of a new 2-week wait pathway that uses the faecal immunochemical test (FIT) in primary care to triage patients with high and low risk symptoms suspicious of colorectal cancer (CRC). This service improvement pilot follows 2017 National Institute for Health and Care Excellence guidance, that recommended using FIT to guide referral of patients with low risk, but not high risk symptoms, which continue to be referrred on the 2-week pathway. Method Patients with high- and low-risk CRC symptoms were tested with FIT and those with faecal haemoglobin (f-Hb) >= 9.5 mu g haemoglobin/g faeces (hereafter mu g/g) were referred to secondary care. Results were tracked and primary care prompted to refer if timely referral was not made. Results Between December 2019 and October 2020, 5672 patients presented to primary care with high and/or low risk symptoms warranting investigations. Of these, 622 (11%) patients were referred without a FIT, of whom 36 (5.8%) had CRC. The remaining 5050 patients had a FIT, of which 4187 (83%) were processed to produce a quantitative result. Of these, 1085 patients (25.9%) had an f-Hb >= 9.5 mu g/g and of those, 982 patients (90.5%) were referred and 56 (5.7%) had CRC. A total of 3102 patients (74.1%) had an f-Hb <9.5 mu g/g, of which 456 (14.7%) were referred and three (0.7%) had CRC. A total of 97 cancers were diagnosed with a cancer prevalence of 1.7%. Conclusion A 2-week wait pathway incorporating FIT as a triage tool can be implemented successfully in primary care to identify symptomatic patients at highest risk of CRC.

Automated summary

This study aimed to evaluate a new 2-week wait pathway that utilizes the faecal immunochemical test (FIT) to screen patients with suspected colorectal cancer (CRC) for high and low-risk symptoms. The results showed that this approach can successfully identify patients at the highest risk of CRC in primary care.