CHS-led study of simple at-home bowel cancer tests could almost halve unnecessary invasive colonoscopy procedures by 2020
29 September 2017
A major study of 6,000 patients in West London is expected to almost halve the number of invasive procedures by 2020 by improving the accuracy of bowel cancer tests.
It could mean more than 100,000 NHS patients in England avoid the need for uncomfortable colonoscopies each year by first getting a reliable ‘all clear’ from a simple at-home test.
It could also save the NHS millions, as each colonoscopy costs the NHS £372 compared to about £5 for the new at-home tests.
The research is led by Croydon Health Service NHS Trust (CHS). It is England’s largest study into the accuracy of the ‘faecal immunochemical test’ (FIT), both in terms of public participants and the number of sites involved.
Its aim is for people to have a highly reliable and very simple FIT test when they go to GPs with possible bowel cancer symptoms.
FIT predicts bowel cancer by precisely recording the presence of any blood in just one gram of faeces. The study will identify how these levels of blood may vary by age, sex and ethnicity – enabling FIT to give very accurate ‘no bowel cancer’ results, regardless of whom is using it.
The same CHS research team conducted a smaller study in 2016(1). It estimated that accurate FIT tests would achieve at least a 40 per cent reduction in ‘unnecessary’ colonoscopies across the West London area (including North West and South West). It is hoped that NICE FIT will find that a similar success rate is achievable throughout the NHS.
There is a vital need for this improvement. Over the past year in England, GPs referred 302,643 patients to have urgent investigations for suspected bowel cancer (an annual increase of 15 per cent)(2). Most of them underwent colonoscopies and more than 95 per cent of them were found not to have bowel cancer after all.
Matthew Wright, host of the television show The Wright Stuff, tragically lost his father and grandfather to the disease and has given his support to the study. He said:
"FIT is simpler and more accurate than any home test we've had before. This should mean more people will use it and, as early detection leads to successful treatment in 90 per cent of cases, FIT should help save thousands of extra lives."
Led by CHS, NICE FIT is a £550,000 collaborative study lasting one year. It involves nine other NHS acute trusts in West London (including North West and South West) and has been identified as a priority project in the ‘NHS Five Year Forward View’ national strategy to improve cancer survival.
It is called NICE FIT because this study of FIT answers a call for evidence from the National Institute for Health & Care Excellence (NICE).
In addition to national support from NICE and NHS England, it is the only national study of FIT to be included in the National Institute for Health Research's (NIHR) Clinical Research Network Portfolio. This means it meets a high standard of peer review and allows NHS sites across England to participate in the study with NIHR support.
Mr Muti Abulafi, a Consultant Surgeon at CHS and Chief Investigator of both the new study and the 2016 local study, said:
“We are so thankful to NHS England, NICE and RM Partners for the opportunity to turn a very good cancer test into a fantastic one. We strongly urge people to take part in this research study, which could benefit millions of future patients with bowel symptoms.”
Cally Palmer, National Cancer Director at NHS England, said:
“We are pleased to support this fantastic study that seeks to revolutionise diagnosis for patients with colorectal symptoms.
“This study, and others like it, is a key component of our transformation plans to improve survival by diagnosing cancer earlier and faster. We will be studying the results closely to see how we can best roll this test out nationally.”
Deborah Alsina MBE, Chief Executive at Bowel Cancer UK said:
“This important study will help to increase understanding of how FIT can be used to better identify people in need of a colonoscopy. It is predicted to help to reduce demand on the overstretched endoscopy service across England. The use of FIT in this way should help speed up the diagnostic process for those at greatest risk of developing bowel cancer. Therefore leading to more people being diagnosed early when the disease is most treatable and curable. We will follow the trial with great interest.”
RM Partners, part of the national Cancer Vanguard for West London, applied to NHS England for funding on behalf of CHS to expand its NICE FIT research across multiple hospital sites. The Trust was awarded the privilege of leading the study because of its previous research with FIT, its track record of excellence in colorectal care and research, and the diverse population that it cares for in the capital.
RM Partners is the cancer alliance that includes CHS and nine other acute trusts. They are: Chelsea and Westminster, Epsom and St Helier, Hillingdon Hospitals, Imperial College Healthcare, Kingston, London North West Healthcare, Royal Brompton & Harefield, St George’s, The Royal Marsden.
Bowel cancer is the fourth most common cancer in England and the second biggest cancer killer. Every year over 34,000 people are diagnosed with bowel cancer in the country and around 13,000 people die from the disease.
During the NICE FIT study patients will continue to have their normal investigations, regardless of their FIT result.
Notes
- (1) The small study by CHS in 2016 was conducted by colorectal surgeon Mr Muti Abulafi (who is Chief Investigator of the new NICE FIT study) and his colorectal research fellow Mr Nigel D’Souza (also working on the new study). It estimated that across West London (including North West and South West) unnecessary colonoscopies could be reduced by at least 40 per cent or approximately 6,800 patients (at the current levels of 17,000 urgent referrals by GPs for bowel cancer tests, resulting in potential savings of £2.5million per year.
- (2) England, N., Waiting Times for Suspected and Diagnosed Cancer Patients: 2016-17 Annual Report. 2017.