Summary
Funders: HCRW and Cancer Research Wales
Background
Bowel cancer is one of the commonest cancers worldwide. Earlier detection results in better outcomes for patients and longer survival. It is a challenge for GPs to diagnose bowel cancer and many symptomatic patients are sent to hospital for tests to rule it out. This is normally a colonoscopy, which is expensive, unpleasant and can be harmful. An accurate faecal test for blood (FIT) has just been introduced as a diagnostic tool for GPs. We are currently working to develop a new blood test for bowel cancer using Raman spectroscopy. Early results indicate that the blood test is very good at correctly identifying patients with bowel cancer. By combining this with the faecal sample test, we hope to further improve its accuracy. We plan to investigate whether the Raman blood test and faeces test combination is acceptable to both patients and their GPs to help them diagnose bowel cancer.
Research aims
To qualitatively explore patient and health professional attitudes and experiences with combined Raman-FIT testing as an alternative to colonoscopy.
We also wish to:
- Determine whether patients comply with the requirements of the combined Raman-FIT test procedure
- Establish the negative predictive value (NPV) of the combined Raman-FIT test procedure in a symptomatic primary care population.
- Establish that moving the point of diagnosis from secondary care testing to primary care is acceptable to both patients and care providers.
- To explore the feasibility of progression to a full trial.
What we hope to discover
By interviewing patients and doctors we hope to discover that the having the simple blood and faecal tests in primary care are an acceptable alternative to having invasive testing in hospital. We hope to learn how accurate the test needs to be in order to be accepted as an alternative way to test for bowel cancer.
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Outcomes
Colorectal (or bowel) cancer is difficult to detect in primary care as its symptoms are non-specific (e.g. rectal bleeding, altered bowel habit). Many patients with these symptoms need referral for a colonoscopy to rule out cancer, yet most colonoscopies are normal. There is a need for simple tests in primary care to help prioritise testing.
The CRaFT study recruited almost 800 patients with symptoms suggestive of bowel cancer to have a novel blood test (Raman test) and a faecal test for blood in stool (FIT). The test pairing was proposed as a method for GPs to risk assess their patients for the likelihood of bowel cancer. Patients and doctors in primary care and in hospital medicine were interviewed to ask their experience with the tests and how the tests could be used in practice.
The Raman/FIT test was acceptable as an alternative to colonoscopy in 91% of interviewed patients.
Patients said that the Raman-FIT test was quicker to access, less invasive, less painful and more convenient compared to other diagnostic tests such as colonoscopy, without the need for time off work or bowel preparation.
Patients said the speed in which the Raman-FIT test can be done would benefit their physical and psychological wellbeing.
Healthcare professionals said they would be confident with Raman-FIT as an initial test and would not immediately refer Raman-FIT negative patients if there was a low clinical suspicion of cancer.
The blood test alone would increase access to initial testing in patients that might otherwise not engage or present and was important for symptoms of rectal bleeding and iron deficiency anaemia.
Patients and healthcare professionals would welcome access to a quicker, less invasive test to screen for colorectal cancer in primary care, and this was a good option for ruling out colorectal cancer in primary care.
Implications are that adoption of the Raman-FIT test in primary care would help patient wellbeing, may increase earlier presentation of less-engaged patient groups to increase cancer detection and would help prioritise demand for colonoscopy in secondary care.
Contact Details
Trial Manager / Lead Contact: Dr Kym Carter
Phone: 01792 606372
Email: craft@swansea.ac.uk