Patient acceptability and clinical effectiveness of combined Raman/FIT testing for colorectal cancer diagnosis in primary care

End of project summary

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.