Non-invasive test to ‘rule-out’ colorectal cancer could transform patient diagnosis in UK’s largest pilot study 

12/04/2017 00:00 
The largest pilot study of its kind in the UK to see if a simple stool test that patients can do in their own homes can effectively ‘rule-out’ the presence of colorectal cancer (also known as bowel cancer) amongst patients with abdominal symptoms, has been launched today by the UCLH Cancer Collaborative.

If the pilot study is successful, the test could reduce the number of patients experiencing unnecessary colonoscopies by 40% and transform the way that colorectal cancer is diagnosed.

The Quantitative Faecal Immunochemical Test, known as qFIT, detects hidden quantities of blood in a stool sample that could indicate colorectal cancer. It is much more sensitive than other similar stool tests currently being used. There is growing evidence that the qFIT test could accurately ‘rule-out’ colorectal cancer for patients with suspicious lower abdominal symptoms with over 95% accuracy.

Currently, patients with symptoms such as abdominal pain or blood in their poo are referred by their GP to a hospital for further investigation such as colonoscopy. This involves inserting a small camera through the rectum up into the lower bowel.

Last year, over 260,000 patients with lower abdominal symptoms were seen by a specialist following an urgent GP referral for suspected cancer. The majority of these had a colonoscopy. But only about 4% of these patients actually had cancer. This means that at present, too many people are having unnecessary colonoscopies. Based on predications there will be a 44% increase in current activity over the next 15 years, imposing a huge burden on already stretched endoscopy departments in hospitals.

The first phase of the pilot is being rolled-out to patients in north central and north east London, and west Essex via over 30 GP practices and six NHS trusts. Patients that have been urgently referred for a lower abdominal examination, due to suspected cancer, will be asked to take the simple qFIT test at home as an addition to their assessment. The results of both the qFIT test and the colonoscopy will then be compared to check that the qFIT test has successfully predicted the result of their colonoscopy. The pilot aims to gather results from a minimum of 2,000 patients in London over six months.

This is the largest study of its kind, and hopes to replicate the results of two smaller studies in Scotland which found that a normal qFIT result showing no evidence of blood in a stool may rule out the presence of colorectal cancer.

Mr Michael Machesney, pilot lead, chair of the London Cancer colorectal pathway board and consultant colorectal surgeon, said:

“The vast majority of colorectal cancers are diagnosed at a late stage which is why it is the second biggest cancer killer. We want more people to receive early diagnosis and survive colorectal cancer.

“If we can successfully prove that the qFIT test can accurately ‘rule-out’ colorectal cancer for patients with lower abdominal symptoms, we can potentially stem the increasing need for colonoscopy resources and transform the way that colorectal cancer is diagnosed.”

Dr Ed Seward, consultant gastroenterologist at UCLH, said:

“Whilst colonoscopy is an excellent tool for diagnosing potentially curable bowel cancer, too many patients are currently coming into hospital to have what turns out to be an unnecessary procedure as the pick-up rate for bowel cancer is tiny - only 4%. We believe that many of them could take this simple stool test in the comfort of their own home, and get reassurance from their GP without needing to come to hospital for a camera test.

“The burden on endoscopy departments is predicted to get even higher over coming years and so, if this pilot is successful, we may be able to reduce the number of unnecessary colonoscopies by perhaps 40%. This is good news for hospitals and good news for patients.”

Dr Imogen Staveley, GP and Primary Care Cancer Lead in Camden, said:

“I’m really excited to be one of the GP practices taking part in the qFIT pilot study. Currently when patients come to see their GP, with symptoms that could indicate colorectal cancer, many will end up being referred for a colonoscopy to investigate further.

“We are hoping that the qFIT test will prove to be a simple, inexpensive alternative to a colonoscopy for lots of patients to rule our colorectal cancer. This would be excellent news for patients as many of them would avoid having to go through a potentially unnecessary invasive procedure.”

Mrs Celia Ingham Clark, Medical Director for Clinical Effectiveness at NHS England, said:

“NHS England is delighted to support the work of the UCLH Cancer Collaborative to pilot qFIT as a rule out test for colorectal cancer. If successful, the results of the pilot study could effect change across the whole of the NHS and change the way that colorectal cancer is diagnosed in England. Scalability and adoption of Vanguard projects across the NHS is a fundamental part of the New Care Models programme to rapidly improve patient outcomes and experience.”

Participating trusts and GP practices include: Barking, Havering and Redbridge University Hospitals NHS Trust, Barts Health NHS Trust, North Middlesex University Hospital NHS Trust, Princess Alexandra Hospital NHS Trust, Royal Free London NHS Foundation Trust, University College London Hospitals NHS Foundation Trust. Barking & Dagenham CCG: Parkview medical Centre (Dr DP Shah's Practice), Thames View Health Centre (Dr Gs Katlakt's Parctice); Barnet CCG: Millway Medical Practice, Holly Park Clinic, Oak Lodge Medical Centre, Penshurst Gardens Surgery, PHGH Doctors , The Speedwell Practice, The Hillview Surgery; City and Hackney CCG: Elsdale Street Surgery, Springfield GP-Led Health Centre, Well Street Surgery; Havering CCG: Central Park Surgery (Kakad), The Greenwood Practice; Islington CCG: Killick Street Health Centre, Ritchie Street Group Practice, The City Road Medical Centre, The Rise Group Practice, The Tufnell Park Surgery; Newham CCG: Dr Pi Abiola's Surgery; Redbridge CCG: Ilford Medical Centre, St. Clements Surgery, Wanstead Place Surgery; Tower Hamlets CCG: City Wellbeing Practice, St Stephens Health Centre, St Andrews Health Centre, The Chrisp Street Health Centre; West Essex CCG: The Loughton Surgery, Lister Medical Centre, Ongar Health Centre, The Eden Surgeries, The Forest Practice.

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