Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey

Wagner, Christian von; Verstraete, Wouter; Hirst, Yasemin; Nicholson, Brian D; Stoffel, Sandro; Laszlo, Helga E

doi:10.3399/bjgpopen20x101007

Cited by 11 publications

(10 citation statements)

References 29 publications

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“…The only other study to address this issue was by Wagner et al who asked public volunteers to imagine they had CRC symptoms, and found 70% would prefer FIT to colonoscopy if the risk of missing cancer was 1%. [16] In our study of truly symptomatic patients, 78% preferred FIT to colonoscopy.…”

Section: Strengths and Limitationsmentioning

confidence: 81%

Faecal immunochemical test for suspected colorectal cancer symptoms: patient survey of usability and acceptability

et al. 2021

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BackgroundRecent evidence suggests that the Faecal Immunochemical Test (FIT) can rule out colorectal cancer (CRC) in symptomatic patients. To date, there is no research on usability and perception of FIT for these patients.AimTo measure variation in attitudes and perception of FIT in patients with suspected CRC symptoms.Design & settingCross sectional survey of a sub-set of participants of the NICE FIT study.MethodA questionnaire was co-developed with patients covering four themes: FIT feasibility, faecal aversion, patient knowledge and future intentions, on a Likert scale. Questionnaire and FIT kits were sent to patients with suspected CRC symptoms participating in the NICE FIT study. Logistic regression explored differences in patients’ test perception by ethnicity, language, age, location, deprivation, FIT use and previous experience.Results1151 questionnaires were analysed; 90.2% of patients found faecal collection straightforward, (95% CI 88.3%–91.8%), 76.3% disagreed FIT was unhygienic (95% CI 73.7%–78.6%), 78.1% preferred FIT to colonoscopy (95% CI 75.6%–80.4%). Preference for FIT over colonoscopy was weaker in patients aged 40–64 than those over 65 years (OR 0.60; 95% CI 0.43–0.84). Intention to use FIT again was stronger in patients who successfully used FIT than those unsuccessful (OR 11.08; 95% CI 2.74–44.75) and white compared to non-white patients (OR 3.20; 95% CI 1.32–7.75).ConclusionsWhile most patients found FIT practical and hygienic, perception differences were found. Strategies to engage patients with more negative FIT perception should underpin symptomatic FIT pathways.

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Section: Strengths and Limitationsmentioning

confidence: 81%

Faecal immunochemical test for suspected colorectal cancer symptoms: patient survey of usability and acceptability

et al. 2021

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“…Use of FIT testing in colorectal low‐risk symptom pathways is likely to be controversial as was the introduction of gFOB by NICE in 2015 2,3 . However, patients and bowel cancer charities may be reassured by the improved performance of FIT compared to gFOB and with appropriate safety netting allow more rapid definitive testing for the at risk population 13 . Commissioners of colorectal cancer services are likely to support this more efficient use of expensive endoscopic resource to target those at highest risk and to potentially reach underserved populations given the simplicity of the test 33 .…”

Section: Discussionmentioning

confidence: 99%

“…The adoption of FIT in primary care has been slow with notable variation in uptake and implementation across England, 5 low awareness of the NICE guidance 11 and low confidence in the accuracy of FIT amongst general practitioners (GPs) 12 . The public report a preference for FIT over colonoscopy if no additional cancers are missed 13 …”

Section: Introductionmentioning

confidence: 99%

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

Nicholson

James

Paddon

et al. 2020

Aliment Pharmacol Ther

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Summary Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence (NICE) to triage symptomatic primary care patients for further investigation of colorectal cancer. Aim To ascertain the diagnostic performance of FIT in symptomatic adult primary care patients. Methods Faecal samples from routine primary care practice in Oxfordshire, UK were analysed using the HM‐JACKarc FIT method between March 2017 and March 2020. Clinical details were recorded. Patients were followed for up to 36 months in linked hospital records for evidence of benign and serious (colorectal cancer, high‐risk adenomas and bowel inflammation) colorectal disease. The diagnostic accuracy of FIT is reported by gender, age group and FIT threshold. Results In 9896 adult patients with at least 6‐month follow‐up, a FIT result ≥10 µg Hb/g faeces had a sensitivity for colorectal cancer of 90.5% (95% CI 84.9%‐96.1%), specificity 91.3% (90.8%‐91.9%), positive predictive value (PPV) 10.1% (8.15%‐12.0%) and negative predictive value (NPV) 99.9% (99.8%‐100.0%). The PPV and specificity for serious colorectal disease were higher and the sensitivity and NPV lower than for colorectal cancer alone. The area under the curve for all adults did not change substantially by gender or by increasing the minimum age of testing. Using ≥10 µg Hb/g faeces, 10% of adults would be investigated to detect 91% of cancers, a number needed to scope of ten to detect one cancer. Using ≥7, ≥50 and ≥150 µg Hb/g faeces, 11%, 4% and 3% of adults would be investigated, and 91%, 74% and 54% cancers detected, respectively. Conclusion A FIT threshold of ≥10 µg Hb/g faeces would be appropriate to triage adult patients presenting to primary care with symptoms of serious colorectal disease. FIT may be used to reprioritise patients referred with colorectal cancer symptoms whose investigations have been delayed by the COVID‐19 pandemic.

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“…Use of FIT testing in colorectal low risk symptom pathways is likely to be controversial as was the introduction of gFOBT by NICE in 2015 (2, 3). However, patients and bowel cancer charities may be reassured by the improved performance of FIT compared to gFOBTs and with appropriate safety netting allow more rapid definitive testing for the at risk population (24). Commissioners of colorectal cancer services are likely to support this more efficient use of expensive endoscopic resource to target those at highest risk and to potentially reach underserved populations given the simplicity of the test (25).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of Faecal Immunochemical Testing for patients with symptoms of colorectal cancer: a retrospective cohort study of 14,487 consecutive test requests from English primary care

Nicholson

James

Paddon

et al. 2020

Preprint

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Objective: To ascertain the diagnostic performance of faecal immunochemical test (FIT) in symptomatic primary care patients, to provide objective data on which to base referral guidelines. Design: Stool samples from routine primary care practice in Oxfordshire, UK were analysed using the HM-JACKarc FIT method between March 2017 to March 2020. Clinical details described on the test request were recorded. Patients were followed up for up-to 36 months in linked hospital records for evidence of benign and serious (colorectal cancer, high-risk adenomas and bowel inflammation) colorectal disease. The diagnostic accuracy of FIT is reported by gender, age, and FIT threshold. Results: In 9,896 adult patients with at least 6 months of follow-up, a FIT result ≥10 ug/g had an overall sensitivity for colorectal cancer of 90.5% (95% CI 84.9%-96.1%), women 90.0 (80.7-99.3), men 90.8 (83.7-97.8); overall specificity 91.3 (90.8-91.9), women 92.4 (91.8-93.1), men 89.8 (88.8-90.7); overall Positive Predictive Value (PPV) 10.1 (8.15-12.0), women 7.64 (5.24-10.0), men 12.5 (9.52-15.5)); and an overall Negative Predictive Value (NPV) 99.9 (99.8-100.0), women 99.8 (99.7-100.), men 99.9 (99.9-100.0). The PPV and specificity of FIT were higher for serious colorectal disease combined and the sensitivity and NPV were lower than for colorectal cancer alone. The Area Under the Curve (AUC) for all patients did not change substantially by increasing the minimum age of testing. In this population, 10% would be further investigated to detect 91% of the cancers at 10ug/g and 3% further investigated to detect 54% of the cancers at 150ug/g. The number needed to scope to detect one cancer at was ten using FIT at 10ug/g. Conclusion: A FIT threshold of 10ug/g is appropriate to triage adult patients presenting to primary care with symptoms of serious colorectal disease. FIT may provide an appropriate approach to reprioritising patients colorectal cancer symptoms whose tests have been delayed by the COVID-19 pandemic.

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Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey

Cited by 11 publications

References 29 publications

Faecal immunochemical test for suspected colorectal cancer symptoms: patient survey of usability and acceptability

Faecal immunochemical test for suspected colorectal cancer symptoms: patient survey of usability and acceptability

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

Diagnostic accuracy of Faecal Immunochemical Testing for patients with symptoms of colorectal cancer: a retrospective cohort study of 14,487 consecutive test requests from English primary care

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