Utilising administrative data to inform FIT-guided suspected colorectal cancer referrals of symptomatic patients

Co-supervisor: Dr Catia Nicodemo, Nuffield Department of Primary Health Care Science

Co-supervisor: Associate Prof. Brian Nicholson, Nuffield Department of Primary Care Health Sciences

Commercial partner: Alpha Laboratories Ltd

Colorectal cancer (CRC) is the third leading cause of cancer death worldwide. In the UK, around 43,000 new CRC cases are recorded annually, and its comparatively high incidence and mortality represent a considerable public health burden.

Early CRC detection plays a crucial role in improving patient outcomes particularly survival rates. This rationale is shared by the diagnostic advisory committee of the National Institute for Health and Care Excellence (England Wales), which in 2017 recommended the use of the faecal immunochemical test (FIT) as a non-invasive diagnostic method to triage patients with symptoms of CRC in the primary care setting for definitive CRC investigation. Since then, the British Society for Gastroenterology (BSG) published guidance recommending FIT in primary care for symptomatic patients in 2022 and NICE are nearing completion of their updated FIT guidance which will continue to recommend FIT in primary care. Apart from the potential of early CRC detection, the widespread utilisation of FIT promises health system-wide benefits, including reductions in unnecessary referrals and therefore waiting times for colonoscopy through more accurate patient selection than using symptoms alone.

This project aims to define the role of administrative data to inform FIT-guided suspected colorectal cancer referrals of symptomatic patients. The underlying objectives of the study are threefold.

Objective 1: Synthesis of current evidence regarding the role of administrative data in cancer research.

As the role of administrative data in cancer clinical research increases, a growing number of studies making use of such data is published. Frequently, arguments are made that observational administrative data, sometimes coined as real-world evidence, could even substitute randomised controlled trials, resulting in considerable cost reductions for cancer clinical research. Objective one entails an extensive evidence synthesis on the strengths and limitations of using observational administrative data for research as well as for regulatory approval of health technologies.

Objective 2: Equity of FIT use in colorectal cancer pathway referrals for symptomatic patients.

Evidence indicates that cancer survival can be affected by social determinants of health, including ethnicity and where individuals live. Under the NHS’ equity framework, it is important that everyone has an equal opportunity for adequate cancer prevention. Objective two will analyse the use of FIT for CRC pathway referrals for symptomatic people in the context of sociodemographic factors to understand associations with timely referrals for cancer investigation. The research will focus on whether certain patient subgroups are less likely to return a FIT test, as this has been a suspected indication stated by NICE. Understanding the equity dimension of cancer pathway referrals and diagnostic uptake rates can provide useful evidence for the development of more population-tailored cancer control strategies. Additionally, the research will focus on colonoscopy referral pathways in FIT-positive and FIT-negative population subgroups, including an analysis of waiting times for colonoscopy.   

Objective 3: Economic evaluation of FIT
 
Evidence from systematic reviews indicate that FIT-guided CRC screening and symptomatic investigation provide a cost-effective/cost-saving use of scarce healthcare resources. However, these developed economic evaluation models are populated with parameters from clinical-effectiveness reviews and expert opinion. Objective three entails the development of a de new economic model to explore the cost-effectiveness of FIT using observational administrative data from NHS hospital trusts and the Clinical Practice Research Datalink (linked to Hospital Episode Statistics and the National Cancer Registration and Analysis Service dataset).

Apply using course: DPhil in Primary Health Care