Original Title: Prueba inmunológica de sangre oculta en heces en pacientes con sintomatología compatible con cáncer colorrectal: recomendaciones de las Guías de Práctica Clínica y su utilización en el Sistema Nacional de Salud

Authors' objectives: 1. Find out the current clinical standards for recommending faecal occult blood tests for patients with clinically suspected CRC. 2. Explore the clinical criteria used in deciding to carry out a faecal occult blood test on symptomatic patients in the NHS. 3. Identify aspects that can be improved in the clinical management of patients with symptoms compatible with CRC.

Authors' results and conclusions: Six CPGs were selected for reading of the entire text. Finally the CPG «Quantitative faecal immunochemical tests to guide referral for colorrectal cancer in primary care» published by the National Institute for Health and Care Excellence (NICE) in July 2017 was the only one to comply with the established selection criteria. Also included was the information from the assessment report titled «Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: A systematic review and cost-effectiveness analysis» commissioned and published by the NICE, on which some recommendations of this CPG are based. The survey carried out on healthcare professionals was completed by 558 persons, 402 of whom were Primary Care professionals (72 %) and 156 of whom worked in Specialist Care (28 %). CONCLUSIONS The most recent CPG recommends the use of OC Sensor, HM-JACKarc and FOB Gold quantitative faecal immunochemical tests in Primary Care to guide referral for suspected CRC in people without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway referral outlined in the previous NICE’s guideline. The use of immunodemical FOBTs on symptomatic patients generally presents a good match with the recomendation of the CPG that was analysed, according to 558 professionals of the NHS that answered the survey. Even so,some discrepancies were noticed, mostly regarding the request for FOBT in patients with rectal bleeding, in the number of faecal samples requested to detect blood hidden in faeces and in the clinical management when the I-FOBT tests are negative or positive.

Authors' methods: Objective no. 1 was fulfilled via a systematic review of Clinical Practice Guides (CPG) based on scientific evidence that provide recommendations for the use of the faecal occult blood test in patients with symptoms compatible with CRC. Objective no. 2 was fulfilled by a survey for professionals in the NHS who work in Primary Health Care or in Specialised Digestive System Care in order to find out about the use of the faecal occult blood test in patients with symptoms compatible with colorectal cancer. The use of these two processes made it possible to fulfil objective no. 3, comparing the results of the survey with the recommendations established in the guides regarding recommendations for faecal occult blood testing, in order to propose measures at NHS level so as to improve clinical management of symptomatic patients and the efficiency of the system, based on knowledge of our environment and the best scientific evidence.

Project Status: Completed

Year Published: 2018

URL for published report: https://www.euskadi.eus/web01-a2aznscp/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=052143&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>