Find out more at www.alphalabs.co.uk/FIT 3 Getting FIT for the Future! FIT for Clinicians - Symptomatic Patients and Screening Programmes Why use FIT? Evidence Base NHS England spent approximately £178.4 million during 2014 on performing colonoscopies (based on NHS tariff price), yet with approximately 40% of those no pathologies were found. Identifying and prioritising those patients more likely to require urgent intervention could save significant costs, reduce waiting times and improve care. Publications support the Faecal Immunochemical Test (FIT) for Haemoglobin (Hb) as a rule out test (NPV of FIT at 10µg Hb/g faeces is 100% for Cancer, 94.6% High-Risk Adenoma (HRA), 93.5% Low-Risk Adenoma (LRA) and Inflammatory Bowel Disease 94%1), and demonstrate that with an increased severity of disease a higher faecal Haemaglobin (F-Hb) concentration is detected. Thus FIT enables management of the patient pathway and most effective use of resources based on appropriate evidence. ■ Personalised Medicine All patients are different and present with a range of symptoms and risk factors. The additional information provided by FIT testing can help determine the optimum management of each individual. ■ Resource Management Waiting times for endoscopy resources are increasing. Performing an initial FIT test to categorise the patient could, with confidence, predict those for whom colonoscopy is not appropriate. This would remove 40% of patients from waiting lists, significantly improving the turn-around time for those remaining, and ensuring their treatment is optimised and actioned sooner. ■ Screening in the Asymptomatic Population Using FIT technology, such as the HM-JACKarc automated system, within a screening programme, enables the adjustment of positive cut off concentration. This helps to control the number of referrals for colonoscopy within the limits of available resources. In addition, the specificity of FIT eliminates false positives caused by dietary factors, ensuring positive results are a true indicator of pathology. Reference 1. Low faecal haemoglobin concentration potentially rules out significant colorectal disease PJ McDonald, et al. Accepted Article’ doi:10.1111/ codi.12087 Concerned about their condition, patients want quick answers, with minimal intervention. With FIT testing they can have access to more information about the symptoms they exhibit and the possible causes for them. Unfortunately IBS and other benign bowel disorders can exhibit similar symptoms to more serious conditions, such as colorectal cancers. As a consequence the longer it takes to resolve these concerns the more anxious patients become. ■ Easier, More Convenient Sample Collection Compared to the traditional card format triple guaiac-based faecal occult blood test, sampling for the HM-JACKarc FIT test is quick and hygienic. Only one faecal sample is required and is collected using a small picker device that is then re-sealed in it’s plastic vial ready for testing. ■ Rapid Response For most, having a rapid non-invasive faecal test to get a faster diagnosis would be the preferred choice. Using a FIT result, about 40% of patients would be informed that no further follow up is necessary and hence relieved straight away. The remaining 60% would have the option of a prioritised process for colonoscopy and get their treatment solutions started sooner. ■ Risk Management Invasive procedures are not without risk, and this is true of colonoscopy. 1 in 1,000 patients may suffer a perforated bowel during this procedure, with additional risk of morbidity. So, with a non-invasive alternative now available shouldn’t that be the first choice? Additionally, delay in identifying any abnormal bowel pathology, also carries a higher risk of mortality. Hence, the ability to identify those at greater risk and then fast track these patients for appropriate colonoscopy and treatment is highly desirable. Treated early before it becomes invasive, bowel cancer has a 93% 5 year survival rate. Normal Low risk adenoma High risk adenoma Cancer Faecal Haemoglobin FIT for Patients - Informed choice
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