FIT for Progress


Leanne James, Senior Biomedical Scientist Gina Sanki, Senior Clinical Scientist

Prof John Geen, Consultant Clinical Scientist

Industry Partner: Alistair McLaren, Alpha Laboratories


Cwm Taf Morgannwg University Health Board


This Bevan Exemplar project, in partnership with Alpha Laboratories, implemented a new laboratory-based technology to guide referral for colorectal cancer in symptomatic adult patients in primary care.


Background


Quantitative faecal immunochemical testing (FIT) has been declared “fit for purpose” by the NICE guidance DG30 for guiding referral for colorectal cancer in symptomatic adult patients in Primary Care.


Aims


The aim of this project was to implement the FIT test in our laboratory to identify patients in primary care who are unlikely to have significant colorectal disease and would not benefit from colonoscopy referral, potentially saving resources and minimising waiting times. We also wanted to create a pathway for primary care with our gastroenterology colleagues and support patient user documentation for the FIT test.


Challenges

  • Local demand and capacity concerns from gastroenterology.

  • The need to standardise documentation for all-Wales use.

  • Agreement of standardised measurable outcomes for use across Wales, and how to obtain this data reliably.


Outcomes


The HM-JACKarc analyser was implemented and interfaced with the all-Wales laboratory software through to Welsh Clinical Portal and Primary care systems.


The service is provided out of Prince Charles Hospital and has full UKAS accreditation (ISO 15189).


Comprehensive documentation has been produced for use across Wales which includes patient feedback. Cwm Taf Morgannwg University Health Board (CTMUHB) are currently running pilot FIT samples for Aneurin Bevan University Health Board GP patients and for a research study (CRaFT) based in Swansea.


Next steps


A local pilot will begin soon in CTMUHB and data can be gathered to look at the impact FIT has on earlier detection of bowel cancer and measure the effect on unnecessary colonoscopy procedures.


The Patient Pack



All the documentation in the patient pack was created as part of the Bevan Commission Exemplar project. Patient feedback was used to create materials that were acceptable to the target patient population. All patients materials are bilingual. These documents are to used across Wales and are already in use by Aneurin Bevan and as part of the CRaFT study. The request form has been developed alongside primary care and gastroenterology colleagues.



Bowel Cancer Survival Rates
Early detection will improve survival

Stage 1
95 out of 100 men (95%) with stage 1 bowel cancer (also called Dukes' A) will survive their cancer for 5 years or more after they're diagnosed.

Stage 4
More than 5 out of 100 men (more than 5%) with stage 4 bowel cancer (also called Dukes' D) will survive their cancer for 5 years or more after they're diagnosed.



Part of cohort Bevan Exemplar Projects 2018-19