Faecal immunochemical tests safely enhance rational use of resources during the assessment of suspected symptomatic colorectal cancer in primary care: systematic review and meta-analysis

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324856
Author(s):  
Noel Pin-Vieito ◽  
Coral Tejido-Sandoval ◽  
Natalia de Vicente-Bielza ◽  
Cristina Sánchez-Gómez ◽  
Joaquín Cubiella
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Healthcare ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Use Of Resources ◽  
Abdominal Symptoms ◽  
Meta Regression Analysis ◽  
Reported Data ◽  
Triage Test

ObjectiveImplementation of faecal immunochemical tests (FIT) as a triage test in primary healthcare may improve the efficiency of referrals without missing cases of colorectal cancer (CRC). We aim to summarise the performance characteristics of FITs for CRC in symptomatic patients presenting to primary healthcare.DesignWe performed a systematic literature review of Medline and EMBASE databases from May 2018 to November 2020. Previous related systematic searches were also adapted to this aim and completed with reference screening. We identified studies performed on adult patients consulting for abdominal symptoms in primary care which reported data such that the FIT diagnostic performance parameters for CRC could be obtained. Bivariate models were used to synthesise available evidence. Meta-regression analysis was performed to evaluate the causes of heterogeneity.ResultsTwenty-three studies (69 536 participants) were included (CRC prevalence 0.3%–6.2%). Six studies (n=34 691) assessed FIT as rule in test (threshold of ≥150 µg Hb/g faeces) showing a sensitivity of 64.1% (95% CI 57.8% to 69.9%) and a specificity of 95.0% (95% CI 91.2% to 97.2%). A threshold of 10 µg/g (15 studies; n=48 872) resulted in a sensitivity of 87.2% (95% CI 81.0% to 91.6%) and a specificity of 84.4% (95% CI 79.4% to 88.3%) for CRC. At a 20 µg Hb/g faeces threshold (five studies; n=24 187) less than one additional CRC would be missed per 1000 patients investigated compared with 10 µg Hb/g faeces threshold (CRC prevalence 2%).ConclusionFIT is the test of choice to evaluate patients with new-onset lower gastrointestinal symptoms in primary healthcare.

scholarly journals Diagnostic accuracy of follow‐up tests for detecting colorectal cancer recurrences in primary care: A systematic review and meta‐analysis

2021 ◽  
Author(s):  
Geertje B. Liemburg ◽  
Daan Brandenbarg ◽  
Marjolein Y. Berger ◽  
Saskia F.A. Duijts ◽  
Gea A. Holtman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Primary Care ◽  
Diagnostic Accuracy ◽  
Meta Analysis

scholarly journals Primary-to-secondary care referral experience of suspected colorectal malignancy in young adults

2016 ◽  
Vol 98 (5) ◽  
pp. 308-313 ◽  
Author(s):  
K Patel ◽  
T Doulias ◽  
T Hoad ◽  
C Lee ◽  
JC Alberts
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Abdominal Pain ◽  
Secondary Care ◽  
Gastrointestinal Symptoms ◽  
Significant Risk ◽  
District General Hospital ◽  
Performance Score ◽  
Colorectal Malignancy ◽  
Presenting Symptoms

Introduction Colorectal cancer in patients younger than 50 years of age is increasing steadily in the UK with limited guidelines available indicating need for secondary care referral. The aims of this study were to report the cancer incidence in those aged under 50 years referred to secondary care with suspected colorectal malignancy and also to analyse the quality of those referrals. Methods A total of 197 primary care referrals made between 2008 and 2014 to a UK district general hospital for suspected colorectal malignancy were analysed. All confirmed cancers were further evaluated regarding presenting symptoms, tumour characteristics and clinical outcomes. Each referral was given a referral performance score (out of 9) dependant on relevant information documented. Results The overall malignancy rate was 9.1% (11 male and 7 female patients). The median age in this cohort was 41.5 years (interquartile range [IQR]: 37–49 years). Abdominal pain was the only presenting symptom to differ significantly when comparing malignant with non-malignant patients (44.4% vs 21.8% respectively, p=0.042). The median time period between referral date and colorectal specialist consultation was 11 days (IQR: 7–13 days) and the median referral performance score was 5 (range: 3–9). Conclusions Malignancy is prevalent in patients under 50 years of age who are referred to secondary care for suspected colorectal cancer. Those referred with abdominal pain in the presence of other high risk lower gastrointestinal symptoms are at significant risk of having a malignancy. Major deficiencies are apparent in urgent primary care referrals, highlighting the need for further national guidance to aid early diagnosis of colorectal cancer in the young.

scholarly journals Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis

BMJ ◽  
2010 ◽  
Vol 340 (mar31 3) ◽  
pp. c1269-c1269 ◽  
Author(s):  
P. Jellema ◽  
D. A. W. M. van der Windt ◽  
D. J. Bruinvels ◽  
C. D. Mallen ◽  
S. J. B. van Weyenberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Primary Care ◽  
Diagnostic Tests ◽  
Meta Analysis

scholarly journals Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines

2020 ◽  
Vol 37 (5) ◽  
pp. 606-615 ◽  
Author(s):  
Marije van Melle ◽  
Samir I S Yep Manzano ◽  
Hugh Wilson ◽  
Willie Hamilton ◽  
Fiona M Walter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Care Patient ◽  
Care Patient ◽  
Bowel Habit ◽  
Level Of Evidence ◽  
Primary Care Population ◽  
Abdominal Symptoms ◽  
Primary Care Patients ◽  
The Uk

Abstract Background Recently, faecal immunochemical tests (FITs) have been introduced for investigation of primary care patients with low-risk symptoms of colorectal cancer (CRC), but recommendations vary across the world. This systematic review of clinical practice guidelines aimed to determine how FITs are used in symptomatic primary care patients and the underpinning evidence for these guidelines. Methods MEDLINE, Embase and TRIP databases were systematically searched, from 1 November 2008 to 1 November 2018 for guidelines on the assessment of patients with symptoms suggestive of CRC. Known guideline databases, websites and references of related literature were searched. The following questions were addressed: (i) which countries use FIT for symptomatic primary care patients; (ii) in which populations is FIT used; (iii) what is the cut-off level used for haemoglobin in the faeces (FIT) and (iv) on what evidence are FIT recommendations based. Results The search yielded 2433 publications; 25 covered initial diagnostic assessment of patients with symptoms of CRC in 15 countries (Asia, n = 1; Europe, n = 13; Oceania, n = 4; North America, n = 5; and South America, n = 2). In three countries (Australia, Spain and the UK), FIT was recommended for patients with abdominal symptoms, unexplained weight loss, change in bowel habit or anaemia despite a low level of evidence in the symptomatic primary care patient population. Conclusions Few countries recommend FITs in symptomatic patients in primary care either because of limited evidence or because symptomatic patients are directly referred to secondary care without triage. These results demonstrate a clear need for research on FIT in the symptomatic primary care population.

scholarly journals Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Knut Holtedahl ◽  
Lars Borgquist ◽  
Gé A. Donker ◽  
Frank Buntinx ◽  
David Weller ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Rectal Bleeding ◽  
Occult Blood ◽  
Distal Colon ◽  
Supplementary Information ◽  
Free Text ◽  
Persistent Symptoms ◽  
Abdominal Symptoms ◽  
Symptoms And Signs

Abstract Background In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. Method Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher’s exact test was used to analyse differences between groups. Results Almost all symptoms recorded could indicate colorectal cancer. ‘Rectal bleeding’ had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had ‘Rectal bleeding’ at the initial consultation, but three of the 18 did so at a later consultation. ‘Abdominal pain, lower part’, ‘Constipation’ and ‘Distended abdomen, bloating’ were less specific and also less sensitive than ‘Rectal bleeding’, and with PPV between 0.7% and 1.9%. Conclusions Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.

scholarly journals What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033481
Author(s):  
Hamish Foster ◽  
Keith R Moffat ◽  
Nicola Burns ◽  
Maria Gannon ◽  
Sara Macdonald ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
English Language ◽  
Mental Health Problems ◽  
Gastrointestinal Symptoms ◽  
Models Of Care ◽  
Out Of Hours ◽  
Abdominal Symptoms ◽  
Language Studies ◽  
Over Time

ObjectiveTo synthesise international evidence for demand, use and outcomes of primary care out-of-hours health services (OOHS).DesignSystematic scoping review.Data sourcesCINAHL; Medline; PsyARTICLES; PsycINFO; SocINDEX; and Embase from 1995 to 2019.Study selectionEnglish language studies in UK or similar international settings, focused on services in or directly impacting primary care.Results105 studies included: 54% from mainland Europe/Republic of Ireland; 37% from UK. Most focused on general practitioner-led out-of-hours cooperatives. Evidence for increasing patient demand over time was weak due to data heterogeneity, infrequent reporting of population denominators and little adjustment for population sociodemographics. There was consistent evidence of higher OOHS use in the evening compared with overnight, at weekends and by certain groups (children aged <5, adults aged >65, women, those from socioeconomically deprived areas, with chronic diseases or mental health problems). Contact with OOHS was driven by problems perceived as urgent by patients. Respiratory, musculoskeletal, skin and abdominal symptoms were the most common reasons for contact in adults; fever and gastrointestinal symptoms were the most common in the under-5s. Frequent users of daytime services were also frequent OOHS users; difficulty accessing daytime services was also associated with OOHS use. There is some evidence to suggest that OOHS colocated in emergency departments (ED) can reduce demand in EDs.ConclusionsPolicy changes have impacted on OOHS over the past two decades. While there are generalisable lessons, a lack of comparable data makes it difficult to judge how demand has changed over time. Agreement on collection of OOHS data would allow robust comparisons within and across countries and across new models of care. Future developments in OOHS should also pay more attention to the relationship with daytime primary care and other services.PROSPERO registration numberCRD42015029741.

scholarly journals Associations between diagnostic pathways and care experience in colorectal cancer: evidence from patient-reported data

2018 ◽  
Vol 9 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Theodosia Salika ◽  
Gary A Abel ◽  
Silvia C Mendonca ◽  
Christian von Wagner ◽  
Cristina Renzi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Patient Survey ◽  
Negative Evaluation ◽  
Hospital Treatment ◽  
Negative Experience ◽  
Care Experience ◽  
Emergency Presentation ◽  
Patient Reported ◽  
Reported Data

ObjectiveTo examine how different pathways to diagnosis of colorectal cancer may be associated with the experience of subsequent care.DesignPatient survey linked to information on diagnostic route.English patients with colorectal cancer (analysis sample n=6837) who responded to a patient survey soon after their hospital treatment.Main outcome measuresOdds Ratios and adjusted proportions of negative evaluation of key aspects of care for colorectal cancer, including the experience of shared decision-making about treatment, specialist nursing and care coordination, by diagnostic route (ie, screening detection, emergency presentation, urgent and elective general practitioner referral).ResultsFor 14 of 18 questions, there was evidence (p≤0.02) for variation in patient experience by diagnostic route, with 6–31 percentage point differences between routes in adjusted proportions of negative experience. Emergency presenters were more likely to report a negative experience for most questions, including those about adequacy of information about their diagnosis and sufficient explanation before operations. Screen-detected patients were least likely to report negative experiences except for support from primary care. Patients diagnosed through elective primary care referrals were most likely to report worse experience for questions for which overall variation by route was generally small.ConclusionsScreening-detected patients tend to report the best and emergency presenters the worst experience of subsequent care. Improvement efforts can target care integration for screening-detected patients and provision of information about the diagnosis and treatment of emergency presenters.

Antidepressants for functional gastrointestinal symptoms and syndromes: A meta-analysis

2001 ◽  
Vol 120 (5) ◽  
pp. A642-A642 ◽  
Author(s):  
R CLOUSE ◽  
C PRAKASH ◽  
R ANDERSON ◽  
P LUSTMAN ◽  
W UNIV
Keyword(s):  
Meta Analysis ◽  
Gastrointestinal Symptoms
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