Spanish recommendations for use of immunological faecal occult blood test for patients with symptoms compatible with colorectal cancer

The immunochemical faecal occult blood test is used for early detection of colorectal cancer in asymptomatic persons at the national level. However, the criteria to be applied to symptomatic patients in order to execute the faecal occult blood test or colonoscopy are unknown.

The objectives of this report are:

• Reveal the current clinical standards for the recommendation of faecal occult blood tests for patients with clinically suspected colorectal cancer;
• Explore the clinical criteria used in deciding to carry out a faecal occult blood test on symptomatic patients in the National Health System;
• Identify aspects that can be improved in the clinical management of patients with symptoms compatible with colorectal cancer.

The first objective was fulfilled via a systematic review of clinical practice guidelines based on scientific evidence that provide recommendations for the use of the faecal occult blood test in patients with symptoms compatible with colorectal cancer. The second objective was fulfilled by a survey, given to the professionals in the NHS who work in Primary Health Care or in Specialised Digestive System Care, in order to find out more about the use of the faecal occult blood test in patients with symptoms compatible with colorectal cancer. These two processes made possible the fulfillment of the third objective, comparing the results of the survey with the recommendations established in the guidelines regarding recommendations for faecal occult blood testing, in order to propose measures at NHS level. This was done to improve clinical management of symptomatic patients and the efficiency of the system, based on knowledge of the environment and the best possible scientific evidence.

Six clinical practice guidelines were selected. The guideline «Quantitative faecal immunochemical tests to guide referral for colorectal 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. «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», assessment report published by NICE was also included. 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 %).

The most recent clinical practice guideline 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 presumed cancer pathway referral outlined in the previous NICE’s guideline. The use of these tests on symptomatic patients in the NHS, in general terms, presents a good match with the recommendations of the clinical practice guideline that was analyzed. 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 faecal occult blood and in the clinical management when the I-FOBT tests are negative or positive.

See the full report in Spanish (with summaries in English and Basque) here.

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