FIT NEGATIVE CLINIC OUTCOMES: EXPERIENCE FROM A TERTIARY CARE HOSPITAL

Background

Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway.¹FIT may be used to triage patients referred with urgent 2-week-wait (2WW) cancer referrals to select appropriate next investigation and its timing after referral.² We audited the outcomes from a FIT negative clinic in a tertiary care hospital.

Methods

Retrospective review of notes for 319 patients on 2ww pathway seen in FIT negative clinic between July-Nov 2020. We collected information on demographics, indication for referral, dates for: referral, clinic visit and outcome. We also looked at the endoscopic and radiological investigations arranged and the outcome from the clinic.

Results

The average age of the patients was 72.45(Median 73, IQR 15) with 53% females. The indications for referrals included anemia-4.1%, iron deficiency-34.2%, weight loss-18.2%, bleeding per rectum-3.1% and change in bowel habits-68.6%. The average time between a referral and FIT was 1.5 days (Median 5, IQR 15.5) with average time from referral to clinic review being 36 days (Median 34, IQR 0). Reassurance was given to 64.6% and 1.6% declined further investigations. Based on clinic review, endoscopy was requested for 16.9% and radiological investigations for 22.3%. of those investigated, 96.3% (104/108) were not found to have cancer. Malignancy was noted for 4 with one each of rectal cancer, rectosigmoid neuroendocrine tumour, oesophageal cancer, and a lung adenocarcinoma. The average time from a FIT test to an outcome from clinic was 40 days (Median 32, IQR 23.5).

Conclusion

We report the experience of using a FIT negative clinic to review patients referred by primary care for further investigations. A FIT negative clinic helps provide safety net to patients who have unexplained symptoms but are at low risk of a cancer. Using a FIT test for triaging we were able to reduce the pressures on endoscopy demands with only 1/6^th of the patients requiring endoscopic investigations after a clinic review. 1) National Institute for Health and Care Excellence, 2017. Diagnostics guidance DG30. 1. Nicholson et al Alimentary Pharmacology & Therapeutics 2020