Faecal immunochemical test-based prediction tools for the assessment of people presenting to primary care with symptomatic bowel disease

Health Technology Wales
Record ID 32018000701
English
Authors' objectives: Colorectal cancer covers cancers in both the colon (colon cancer or bowel cancer) and rectum (rectal cancer). It’s one of the most common cancers in Wales, with about 2,300 new cases in Wales each year. Faecal immunochemical tests can detect small amounts of blood in stool samples. They can help GPs decide if people with unexplained CRC-associated symptoms, but no rectal bleeding, should be referred for more urgent tests. Other characteristics, such as age or gender, can also help GPs identify people who are at risk. HTW has assessed tools that included faecal immunochemical tests and other characteristics, to help NHS Wales decide whether to use these tools.
Authors' results and conclusions: HTW found evidence for two different tools: FAST and COLONPREDICT. FAST uses the faecal immunochemical test with age and sex. COLONPREDICT uses the faecal immunochemical test with 11 other characteristics, including age, sex and other tests. There isn’t enough evidence to recommend the FAST tool or COLONPREDICT tool specifically in addition to FIT.
Authors' recommendations: The evidence supports the adoption of FIT to guide the referral of patients with lower gastrointestinal symptoms for colonoscopy. The use of the FIT-based prediction tools FAST and COLONPREDICT shows promise but the incremental benefits as compared with FIT alone are uncertain from the evidence currently available. HTW therefore supports the adoption of FIT as recommended by NICE Diagnostic Guidance 30 but proposes that a prospective and structured evaluation of the clinical and cost benefits of combining FIT with the prediction tools FAST and COLONPREDICT be incorporated into the implementation strategy in NHS Wales.
Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.
Authors' identified further research: Further studies to develop and validate FIT-based prediction tools for people presenting with lower abdominal symptoms in primary care, but who do not meet the two-week referral criteria, are recommended. Large, prospective, comparative multicentre studies are recommended to evaluate the comparative effectiveness of FIT-based prediction tools against FIT alone, other FIT-based redictions tools, and prediction tools that do not include FIT.
Details
Project Status: Completed
Year Published: 2018
URL for published report: https://www.healthtechnology.wales/reports-guidance/faecal-immunochemistry-test-based-prediction-tools/
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: Wales, United Kingdom
MeSH Terms
  • Colorectal Neoplasms
  • Early Detection of Cancer
  • Occult Blood
Keywords
  • Colorectal cancer
  • Diagnosis
  • Faecal immunochemical testing
Contact
Organisation Name: Health Technology Wales
Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD
Contact Name: Susan Myles, PhD
Contact Email: healthtechnology@wales.nhs.uk
Copyright: Health Technology Wales
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.