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Faecal immunochemical testing

FIT Navigators at Leeds Teaching Hospitals NHS Trust explain the test’s role in the Leeds Colorectal Cancer Pathway.

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Bowel cancer is the fourth most common cancer in the UK with around 40,000 people diagnosed each year. Thanks to advances in research, 10-year bowel cancer survival rates are over 50%. All eligible patients are offered routine bowel cancer screening every two years, with the programme expanding to cover those aged 50–74. In England, in June 2019, the faecal immunochemical test (FIT) was introduced. The FIT kit is now sent with all bowel cancer screening invitations, and if the result is greater than 120 µg Hb/g (80 µg Hb/g in Scotland), the patient will be offered further investigations.

Routine screening is incredibly useful for detecting bowel cancer; however, symptomatic patients do not have to wait patiently for their screening invitation. Patients with bowel symptoms, rectal bleeding and/or iron deficiency anaemia should have a FIT requested as the first line of investigation. At Leeds Teaching Hospitals NHS Trust, if their FIT result is greater than 10 µg Hb/g they will be escalated to a two-week wait Cancer Pathway and have further investigations. Those with a FIT result below this can be managed in Primary Care, often reducing the need for unnecessary invasive procedures. Recent research shows that with a threshold of 10 µg Hb/g, FIT has a sensitivity of 90.9% and a negative predictive value of 99.6% for colorectal cancers (CRC). NICE has provided evidence-based guidance that streamlines cancer referrals, using FIT to identify those at risk of CRC. This guidance ensures that patients with a high risk of CRC can be triaged in a timely manner, with few delays to diagnosis and treatment. The FIT is key in reducing strain on endoscopy units, lowering cancer waiting times and ensuring appropriate follow-up without sacrificing patient care.

Our role as FIT Navigators is to support all patients who have had a FIT requested as part of the Leeds Colorectal Cancer Pathway. Not every patient will have been given the same information and we aim to close that gap by speaking to patients directly. We monitor FIT requests from the point of request, right through to the point a sample has been received and successfully tested by the lab. The main purpose of our role is to safety-net the test, collaborating with primary care and pathology. We contact patients over the telephone, putting them at ease and giving them the opportunity to ask any questions. This allows the patients to make an informed decision about their care, encouraging equal access to support. When a patient returns a sample and it is unable to be tested, we contact the patient to inform them of the reason for rejection, sending them a new FIT pack and request through the post directly to their home address. This improves the response rates and reduces the time between requests and results, enhancing the patient experience and allowing them to progress in their healthcare investigations.

Leeds has a diverse community of patients with individual differences, some of whom might need extra support – that’s where we fit in.  

Lorraine Kennedy, Anthony Musgreave and Kerry-Anne Revie are FIT Cancer Pathway Managers/Navigators at Leeds Teaching Hospitals NHS Trust.

Image credit | Science Photo Library

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