FIT-HB PATHWAY FOR PRIMARY CARE IN HEREFORDSHIRE: THE FIRST 6 MONTHS

Introduction NICE guidance recommended FIT-Hb for routine use in Primary Care to “guide referral of symptomatic patients with LGI symptoms in absence of LGI red flag symptoms (NICE NG12/DG30) FIT-Hb offers a negative predictive value ≥ 99% for the exclusion of Colorectal Cancer and High Risk Polyps BCSP age-extension is anticipated to increase LGI endoscopy demand by 8–00%. FIT-Hb testing may reduce unnecessary investigations A primary care FIT-Hb diagnostic pathway has recently been launched in Herefordshire. We present the first 6 month data Patients with unexplained LGI symptoms who do not meet the criteria for a suspected LGI cancer pathway triaged using FIT-Hb pathway and proforma request form Indication for FIT-Hb (inclusion criteria) 1- Aged ≥ 50 yrs with: - Change in Bowel Habit OR - Unexplained Abdominal pain OR - Unexplained Weight loss alone OR 2- Aged ≥ 60 yrs with: - Anaemia (without iron deficiency) FIT cut-off (Alpha-Labs): POSITIVE ≥10 µg Hb/g faeces = Referral via 2WW Pathway NEGATIVE Methods Prospective data collection (July to December 2018). Data collected from FIT request forms, endoscopy, pathology, radiology system and clinic correspondence. Data collected on demographics, indication and adherence to inclusion criteria, result and clinical outcome. Results 13 GP practices enrolled in pilot. 97 patients underwent FIT-Hb testing (87% had complete data). All patients were ≥50 years (average 70y, 33% male). Inclusion criteria were met in all patients, change in bowel habit (51%), unexplained abdominal pain (39%), 16% ≥ 1 indication. FIT-Hb positive in 20 patients (24%, range 1–93 µgHb/g). All patients were referred for 2WW GI investigation, 75% colonoscopy, 20% CT-Colonography, 5% no investigation to date. Diagnostic outcomes: Colorectal cancer (2), colonic polyps (3, all low risk polyps), diverticular disease (2), colitis (1) Despite a negative FIT-Hb result, 2 patients (4%) ultimately had colonoscopy (1 low risk polyp detected). No FIT-Hb-negative patients diagnosed with LGI malignancies during the limited follow-up period (– months). Conclusions Assuming all FIT-Hb tested patients would have been referred to secondary care for lower GI investigation, the data suggests 72% reduction in outpatient referral and colonoscopy/CTC. No CRC diagnoses were missed by a negative FIT-Hb during the limited follow-up period. Direct verbal feedback suggests the enrolled GP practices have confidence in the pathway. Prospective data collection continues, but based on the limited pilot data and recent NICE recommendation, a FIT-Hb pathway has been formally commissioned by the Herefordshire CCG.