Using the Faecal Immunochemical Test (FIT) in the Lower Gastrointestinal (GI) pathway

New evidence based and NICE accredited guidelines on the use of FIT by the British Society of Gastroenterology (BSG) and the Association of Coloproctology of Great Britain & Ireland (ACPGBI) have been published. The recommendations include:

• the use of FIT in primary care for patients presenting with all NG12 suspected colorectal cancer symptoms (excluding anal/rectal mass or anal ulceration), and
• those patients with a FIT of fHb <10 μg Hb/g, a normal full blood count and no ongoing clinical concerns are not referred on a lower GI urgent cancer pathway, and are instead managed in primary care or referred on an alternative pathway.

NHS England have now called for these recommendations to be implemented in full. Two NHSE letters on FIT have been sent to primary and secondary care detailing how the guidelines should be applied.

Details of a Wessex model are being finalised and will be communicated as soon as possible. In the meantime please continue to request FIT on all your patients with concerning colorectal symptoms, including rectal bleeding.

Read more here

Lung cancer

Lung cancer is the 3rd most common cancer in the UK with over 48,000 new cases each year. It is also the cancer with the highest mortality rate in the UK accounting for 21% of all cancer deaths. 

Survival is closely linked to the stage at diagnosis with 57% 5-year survival for Stage 1 cancers dropping to 3% 5 year survival for Stage 4 cancers. Many lung cancers are advanced at diagnosis with over 34,000 lung cancer deaths annually in the UK.

Increasing age and tobacco exposure remain the most important risk factors for lung cancer. However, 10-25% of lung cancers occur in never smokers.

There is a strong correlation between deprivation and lung cancer. In England, lung cancer incidence rates in females are 174% higher in the most deprived quintile compared with the least, and 168% higher in males.

Symptoms

Early symptoms of lung cancer can mimic common illnesses making diagnosis difficult especially during the Covid pandemic:

• cough
• fatigue
• shortness of breath
• chest pain
• weight loss
• appetite loss

The unexplained presence of two of these symptoms in never-smokers aged 40 or older, or just one of these symptoms in people who have ever smoked aged 40 or older should prompt an urgent chest X-ray. As should any of the following signs in anyone over 40:

• persistent or recurrent chest infection
• finger clubbing
• supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
• chest signs consistent with lung cancer
• thrombocytosis

Clearly if a patient under 40 years of age has suspicious symptoms they also need investigating, the NICE guidelines are exactly that - a guide.

However, chest X-rays miss 25% of lung cancers making it important for neither GP nor patient to be reassured by a negative chest X-ray in the presence of ongoing symptoms. In this instance a 2 week wait fast track referral should be completed using the “Normal chest x-ray but clinical suspicion” tick box.

Unexplained haemoptysis in a patient aged 40 or older should also prompt a lung cancer 2 week wait fast track referral, as these patients require a CT scan (an X-ray is not mandatory prior to referral and should not slow down a referral, however it may help acute trusts triage the referrals and arrange the most appropriate CT scan).

The treatment for lung cancer depends on the stage at diagnosis. At stage one, treatment can be curative. However, as mentioned earlier patients often present with late stage disease. Targeted lung health checks (see below) are being rolled out across the UK to try and tackle this issue.

Lung cancer statistics | Cancer Research UK

Lung cancer | Cancer Research UK 

Suspected cancer: recognition and referral | NICE Guideline [NG12]

Targeted Lung Health Checks in Wessex

Targeted lung health checks (TLHCs) are specialist nurse-led lung health assessments for smokers and ex-smokers aged 55-74*.

The purpose of the TLHCs is to assess participants risk for undetected lung conditions such as COPD and lung cancer and NHS England is planning to roll out TLHCs across England over the next 5 years.

The checks involve a clinical risk assessment, with spirometry forming part of this at some sites. If a patient is found to be at high risk of lung cancer, they are offered a low dose CT scan.

There are now more than 20 sites across the UK performing targeted lung health checks and to date at least 600 people have been diagnosed with lung cancer, allowing them to receive treatment, which in some cases, has been curative. It is hoped that targeted lung health checks will be shown to reduce lung cancer mortality rates. The findings from an early pilot project in Manchester showed a stage-at-diagnosis change from 18% to 68% for stage one disease and similar results have been found in other areas.

In Wessex, there are TLHC pilots in Southampton and Portsmouth, both of which are finding early-stage lung cancer. A third Wessex pilot is due to start in Dorset later this year. This will be followed by a gradual roll out across the rest of Wessex over the coming years.

For more information and videos of the TLHC process and of patients journeys please visit:

Lung health check - Cancer Matters Wessex

Targeted Lung health checks - Welcome to Wessex Cancer Alliance

* excluding patients who are on end-of-life treatment or who have lung cancer or lung metastases (within 5 years of diagnosis).

Case Study: Cancer Care Coordinator

A growing number of PCNs across Wessex are recruiting Cancer Care Coordinators to support patients across the cancer pathway. 

Cancer Care Coordinator at Winchester Rural and North East PCN Rebecca Hardman told us about her role: 

I have been working as a Cancer Care Coordinator since March 2022, having previously worked in complex needs community healthcare, and I have really enjoying settling into my new role.

Since joining the PCN, I have been supporting our 6 practices with cancer screening programmes, monitoring and auditing the uptake of cervical, bowel and breast cancer screening, whilst identifying and coding non-responders where possible. Alongside this, I have been supporting the achievement of QoF Indicators and assisting with the DES, LIS and IIF workloads.

As part of developing my role, I have started taking referrals from our GP’s to undertake 3 month cancer care reviews over the telephone and during home visits. I feel this has provided value to our recently diagnosed patients and the practices that support them, allowing extra time to support patients and helping to follow up questions and discussions with the healthcare professionals looking after them. Supporting patients has always been my priority, so being given the additional training and flexibility to incorporate this into my job has been extremely valuable.

Dr Christine Glew, Clinical Director of the PCN added:

Recruiting Rebecca as a Cancer Care Co-ordinator has been one of the most valuable roles we have added for the benefit of the practices and patients to date. We were very lucky to attract a candidate with a clinical background and to have the support of the WCA when she started - she has exceeded our expectations in terms of improving cancer screening rates and is now taking on additional training to undertake more direct patient contact which I know she loves and will excel at. I would highly recommend this role to any PCN and the new support package to assist with recruitment will make the task straightforward.

Interested in recruiting a Cancer Care Coordinator?

Wessex Cancer Alliance have developed a package of support to help you recruit and train new Cancer Care Coordinators including an induction pack and community of practice. For more information please contact tamzen.hogben@nhs.net.

Promoting breast health awareness

The Wessex Cancer Alliance Breast Awareness Project aims to support practice nurses to educate patients about breast health during routine cervical screening appointments and encourage them to check their breasts (self-check).

After submitting expressions of interest, 4 pilot practices from across Wessex were selected to take part: Living Well (Southampton); Waterside Health (Hayling Island); South Wight Medical (Isle of Wight), and Grove Medical Centre (Dorset).

The practices were provided with a box of useful resources (known as a 'Boob Box') which holds leaflets and shower stickers along with helpful guides for the nursing teams on how to promote breast self-awareness in practice. These resources have been kindly provided by breast cancer charity CoppaFeel.

The project started on October 1^st and will run for 6 months. Please contact Tamzen Hogben for more information tamzen.hogben@nhs.net.

Clinical Trials for Cancer Patients

Covid caused many clinical trials to come to a premature stop and recovery since then has been slow and difficult. In Wessex currently around 150 clinical trials are open to recruitment and the Clinical Research Network would like your help to promote these important trials.

A recent issue of the Wessex Cancer Alliance bulletin focused on this, please read more here.

Vacancy - Primary Care Advisor (Portsmouth & South East Hampshire)

Wessex Cancer Alliance are looking to recruit a Primary Care Advisor to progress the cancer agenda in the Portsmouth and South East Hampshire system. This role was previously undertaken by a Macmillan GP however we would like to recruit the right individual with the right skills and are keen to receive expressions of interest from a range of healthcare professionals working in primary care.

For more information on the vacancy and how to apply see here.