Diagnosis and treatment
- Phase one – began in 2019 following the publication of NICE DG30 guidance, for patients with less than 3% risk of cancer. GPs ask patients with bowel symptoms to complete a FIT at home. If the FIT is negative, the patient has almost certainly no bowel cancer. If the test is positive, the GP will refer the patient to hospital for further tests.
- Phase two – FIT was incorporated from June 2020 into the NHS England lower gastrointestinal (GI) cancer pathway to ensure appropriate care during the COVID-19 pandemic. FIT was introduced to triage high risk symptomatic patients (who have a more than 3% suspicion of cancer). GPs ask patients with worrying lower abdominal symptoms (other than highly suspicious symptoms such as a mass), to complete a FIT before referring patient to the hospital. If the FIT is negative, the patient almost certainly has no bowel cancer (99.5% unlikely). If the test is positive the patient will be referred by their GP to hospital for fast-track investigation.
- Phase three – new safety netting in secondary care (April 2021 – April 2022)
A new pathway for patients who have lower abdominal symptoms which might suggest bowel cancer but who have a negative FIT test. This means they have a very low risk of having bowel cancer but it cannot be ruled out entirely.
In a year-long service evaluation project, GPs across north central London will refer these patients to hospital instead of waiting to see if symptoms worsen over a period of time. The patients will attend a dedicated follow-up clinic 8-10 weeks after their referral. A consultant or other senior healthcare professional will assess the patient’s repeated FIT and blood test results done prior to the follow-up clinic and any changes in their symptoms to define the treatment plan. The follow-up clinic will offer reassurance to the majority of people who do not have cancer and will enable fast track examination for those who require further tests. By auditing the follow-up pathway, the Cancer Alliance will build an evidence base for best practice in bowel cancer safety netting.
There is more information here for healthcare professionals about the changes in the lower GI pathway.
- Phase four – redefining best practice for the management of patients with bowel symptoms (Spring 2022)
The clinical evidence gathered from the service evaluation audit will be used to refine the lower GI cancer pathway. The proposition is that safety netting for symptomatic patients should in the longer term move into primary care.