The use of the faecal immunochemical test during the COVID‐19 pandemic to triage urgent colorectal cancer referrals

Abstract

Aim During the first wave of the COVID‐19 pandemic in 2020, elective gastrointestinal endoscopy services were abbreviated for fear of viral transmission. However, urgent suspected colorectal cancer (CRC) referrals continued. Serendipitously, a national study suggested that a new faecal immunochemical test (FIT) might be helpful in triaging patients with colorectal alarm symptoms. Methods This was a single centre observational study of patients referred using NG12 criteria between March and August 2020. Patients were triaged to the urgent cancer pathway for FIT ≥ 10 μg/g and investigated using the latest National Health Service England guidance. Demographic data, method of investigations, cancer and polyp detection rates were compared to patients referred in the 6 months prior to the use of FIT as a triage tool. Results In all, 1192 patients (median age 70) were referred using NG12 guidelines during the pandemic period, compared with 1592 patients (median age 72) in the previous 6 months. CRC detection was similar in both groups ( n = 45, 2.8% vs. n = 38, 3.5%; P = 0.248). Two patients with a negative FIT (0.36%) had CRC. Using FIT as a triage tool resulted in a significant reduction in the use of endoscopy ( n = 477, 43.6% vs. n = 1186, 74.5%; P > 0.001) with a significant increase in CT scanning ( n = 696, 63.6% vs. n = 750, 47.1%; P < 0.001). Conclusion The use of FIT in NG12 patients triaged during the first wave of the COVID‐19 pandemic reduced endoscopy but not CT scanning and did not compromise CRC detection rates. It is a safe method that aids in reducing the burden on services greatly. A negative FIT test does not absolutely exclude CRC.

Efficacy and accuracy of faecal sampling by a digital rectal examination for faecal immunochemical testing

“…FIT has rapidly taken off for symptomatic patients and the application is not solely for lowrisk patients as a rule in investigation as per the NICE guidance from 2017 15 . The results of the NICE FIT study demonstrated the high sensitivity of FIT for high-risk patients in primary care as a rule out investigation 16 and FIT has been shown to be safe and effective for TWW patients in the coronavirus pandemic to better allocate diminished endoscopy capacity 17,18 .…”

“…16 The results of the NICE FIT study demonstrated the high sensitivity of FIT for high-risk patients in primary care as a rule out investigation, 17 and FIT has been shown to be safe and effective for TWW patients in the coronavirus pandemic to better allocate diminished endoscopy capacity. 18,19 Therefore, we suggest that FIT via DRE could also be applied in primary care as a rule out investigation for potential TWW patients. Furthermore, there is interest growing for repeat FIT to further improve sensitivity [20][21][22] in this situation, DRE sampling may also be the method of choice to obtain the additional test.…”

Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study

“…Recent studies do show that FIT has the potential to be used more widely 9 10 17. Furthermore, recent evidence of the expanded use of FIT in England during the COVID-19 pandemic shows a range of positive outcomes, including reduction in mortality,18 significant reduction in the use of endoscopy without compromising CRC detection rates35 and successful prioritisation of patients with a higher risk of cancer when endoscopy services were severely restricted 36. GPs also had positive views on the use of FIT during the COVID-19 pandemic 37.…”