FIT for symptomatic patients. Facilitator name

Transcription

1 FIT for symptomatic patients Facilitator name

2 Context colorectal cancer

3 Colorectal cancer in the UK 41,804 new cases in ,903 deaths in 2014 Fourth most common cancer Second most common cause of cancer death

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5 HOW AND WHEN BOWEL CANCER PATIENTS ARE DIAGNOSED

6 Optimising recognition and referral

7 NICE Cancer Recognition and Referral guidelines NG12 June 2015 July 2017 NG12 released, giving new recommendations for recognition and referral of suspected cancer in primary care Patients with higher risk symptoms recommended for urgent suspected cancer referral (2WW) Faecal occult blood testing recommended for patients with low risk but not no risk signs/symptoms Varied local implementation of low risk recommendation Diagnostic guideline (DG) 30 released recommending use of Faecal Immunochemical Test (FIT), a type of faecal occult blood test, in low risk but not no risk patients DG30 replaced recommended in NG12

8 Patients recommended for Suspected Cancer Pathway (2WW) Refer on 2WW if: 40y with unexplained weight loss and abdominal pain 50y with unexplained rectal bleeding 60y with iron deficiency anaemia (IDA) or change in bowel habit Positive faecal occult blood test Consider referral on a 2WW if: Rectal or abdominal mass <50y and rectal bleeding + any of: abdominal pain, change in bowel habit, weight loss or IDA

9 For the low risk but not no risk patients In the South West this test will be offered to patients without rectal bleeding who: Are aged 50y or over with abdominal pain or weight loss Are aged between 50 and 60 and have a change in bowel habit or IDA Aged 60y or over and have anaemia, even in the absence of iron deficiency

10 What is FIT? Specific to human haemoglobin (unlike the guaiac occult blood test) It is being rolled out into the bowel screening programme, but with a very different cut off to determine an abnormal test There are also some projects investigating its use as a triage test in more high risk symptomatic patients So there s a lot of confusion to overcome

11 To help address the confusion The National Clinical Director for Cancer, Chris Harrison, wrote to Cancer Alliances in February 2018 Advises Cancer Alliances to prioritise the full implementation of DG30 (use of FIT in the low risk but not no risk patients) Does not encourage the use of FIT in high risk patients (those meeting the criteria for 2WW suspected cancer URGENT referral)

12 Local pathways

13 FIT implementation in the South West How do GPs order the test? We have appointed two labs to provide the analysis of the test RD&E and NBT. These labs will send out a supply of test kits to all practices in the region. When an eligible patient presents you will need to give the patient the kit and complete a referral form. The patient will then take away the kit, complete it and return it straight to the lab. The results of the test will be sent straight to your practice within 10 working days. If you require further test kits you will be able to order them from the lab. What happens if the test is positive? As recommended by NICE we have set the threshold for a positive FIT test to be 10µg haemoglobin/g of faeces. If a patient has a positive result they are eligible for a suspected cancer referral for further investigation. Faecal occult blood can be caused by a wide variety of benign conditions as well as colorectal cancer, so further assessment is appropriate to establish a diagnosis. What happens if the test is negative? If a patient has a negative FIT then they have a very low risk of colorectal cancer. Your patient does not require a suspected cancer referral, but consider seeking specialist advice in line with local arrangements if worrying symptoms persist.

14 What should GPs and the practice teams be aware of? Not all patients with bowel cancer will have a positive FIT test, so it s important to remain vigilant Some of the symptoms in the low risk, not no risk group may be linked to cancers other than bowel cancer FIT thresholds used in screening is different to FIT thresholds in symptomatic patients This means that patients who have a negative screening result may still have bowel cancer and should be offered a symptomatic FIT test if appropriate

15 How CRUK facilitators can support

16 How can our local Facilitators support FIT implementation? Promotion of symptomatic FIT at practice visits Supporting the organisation and delivery of GP education events Supporting practices to increase familiarity with local pathways Facilitating discussions around symptomatic FIT specific safety-netting to practices Supporting practices to conduct appropriate audits and SEAs

17 Thank you. Any questions? For further support with FIT please contact