Faecal immunochemical test (FIT) in English primary care: for whom and for what symptoms?

September 20th, 2022

A new paper published by BMJ Open (British Medical Journal) describes symptoms that prompt a faecal immunochemical test (FIT) request in primary care – it also shows disagreement between patient-reported and GP-recorded symptoms.

The use of the faecal immunochemical test (FIT) for patients presenting in primary care with symptoms that may indicate colorectal cancer has been increasing in the UK (the FIT is a self-administered stool test taken in the comfort of a patient’s own home). However, evidence is still limited on how FIT guidance is used, for what patients, and for what symptoms. The FIT-East study shed light on these issues, investigating the primary care use of FIT for symptomatic patients in the East of England.

This prospective, descriptive study included 310 symptomatic patients aged ≥40 years for whom a FIT was requested by a doctor in primary care. Under a quarter (23%) of FIT results were positive. Change in bowel habit (69%) and fatigue (57%) were the most commonly reported symptoms among patients, while GPs most often reported on abdominal pain (25%) and change in bowel habit (24%). GPs recorded symptoms less often, and recorded fewer symptoms per patient (median 1 symptom, IQR 1–1), compared with patients (median 5, IQR 3–6).

Percentage agreement between patient-reported and GP-recorded symptoms varied from 44% for fatigue to 80% for unexplained weight loss. Kappa agreement (a statistical score measuring the agreement levels between the two parties) was universally low across symptoms. On the other hand, the proportion of GPs recording symptoms often increased based on patient-reported symptom severity, particularly for alarm symptoms such as rectal bleeding, abdominal pain and unexplained weight loss. Dr Natalia Calanzani, the lead author in the study, said:

“We believe this is the first study in England to report on symptom agreement between patient-reported and GP-recorded symptoms when a FIT is requested in primary care. The identified disagreement is important as there may be implications for cancer risk assessment. For example, risk assessment tools and algorithms using GP-recorded symptoms may be underperforming. Results may also have wider implications for patient management in primary care, as persisting symptoms may affect patient quality of life”.

This research was funded by the CanTest Collaborative. It is part of a larger study that has also investigated the experience and acceptability of using FIT in English primary care (manuscript in preparation). Related CanTest funded studies include FIT-International and FIT-Southwest.