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A novel blood based triage test for colorectal cancer in primary care: a pilot study

Cerys Jenkins, Freya Woods, Susan Chandler, Kym Carter, Rhys Jenkins, Andrew Cunningham, Kayleigh Nelson, Rachel Still, Jenna A Walters, Non Gwynn, Wilson Chea, Rachel Harford, Claire O'Neill, Julie Hepburn, Ian Hill, Heather Wilkes, Greg Fegan, Peter Dunstan Orcid Logo, Dean Harris Orcid Logo

BJGP Open, Volume: 7, Issue: 1, Start page: BJGPO.2022.0077

Swansea University Authors: Peter Dunstan Orcid Logo, Dean Harris Orcid Logo

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DOI (Published version): 10.3399/bjgpo.2022.0077

Abstract

Background: The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is...

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Published in: BJGP Open
ISSN: 2398-3795
Published: Royal College of General Practitioners 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63168
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>63168</id><entry>2023-04-17</entry><title>A novel blood based triage test for colorectal cancer in primary care: a pilot study</title><swanseaauthors><author><sid>eada15d4d33fcb3dfddcff43f1323bd6</sid><ORCID>0000-0002-4337-4307</ORCID><firstname>Peter</firstname><surname>Dunstan</surname><name>Peter Dunstan</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>731533890c5123febe4f65dffd369f7b</sid><ORCID>0000-0003-2673-8946</ORCID><firstname>Dean</firstname><surname>Harris</surname><name>Dean Harris</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2023-04-17</date><deptcode>SPH</deptcode><abstract>Background: The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is a pressing need for access to simple triage tools in primary care to help prioritise patients for referral. Aim: To evaluate the performance of a novel spectroscopy-based CRC blood test in primary care. Design &amp; setting: Mixed-methods pilot study of test performance and GP focus group discussions in South Wales. Method: Patients on the urgent suspected cancer (USC) pathway were recruited for the Raman spectroscopy (RS) test coupled to machine learning classification (‘Raman-CRC’) to identify CRC within the referred population. Qualitative focus group work evaluated the acceptability of the test in primary care by thematic analysis of focus group theorising. Results: A total of 532 patients aged ≥50 years referred on the USC pathway were recruited from 27 GP practices. Twenty-nine patients (5.0%) were diagnosed with CRC. Raman-CRC identified CRC with sensitivity 95.7%, specificity 69.3% with area under curve (AUC) of 0.80 compared with colonoscopy as the reference test (248 patients). Stage I and II cancers were detected with 78.6% sensitivity. Focus group themes underlined the convenience of a blood test for the patient and the test’s value as a risk assessment tool in primary care. Conclusion: The findings support this novel, non-invasive, blood-based method to prioritise those patients most likely to have CRC. Raman-CRC may accelerate access to diagnosis with potential to improve cancer outcomes.</abstract><type>Journal Article</type><journal>BJGP Open</journal><volume>7</volume><journalNumber>1</journalNumber><paginationStart>BJGPO.2022.0077</paginationStart><paginationEnd/><publisher>Royal College of General Practitioners</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2398-3795</issnElectronic><keywords>colorectal neoplasms, two-week waitpilot projects, qualitative research, Raman spectroscopy, primary health care, general practice</keywords><publishedDay>1</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-03-01</publishedDate><doi>10.3399/bjgpo.2022.0077</doi><url>http://dx.doi.org/10.3399/bjgpo.2022.0077</url><notes/><college>COLLEGE NANME</college><department>Physics</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>SPH</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2023-05-18T14:07:14.0128819</lastEdited><Created>2023-04-17T10:24:24.0778764</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Biosciences, Geography and Physics - Physics</level></path><authors><author><firstname>Cerys</firstname><surname>Jenkins</surname><order>1</order></author><author><firstname>Freya</firstname><surname>Woods</surname><order>2</order></author><author><firstname>Susan</firstname><surname>Chandler</surname><order>3</order></author><author><firstname>Kym</firstname><surname>Carter</surname><order>4</order></author><author><firstname>Rhys</firstname><surname>Jenkins</surname><order>5</order></author><author><firstname>Andrew</firstname><surname>Cunningham</surname><order>6</order></author><author><firstname>Kayleigh</firstname><surname>Nelson</surname><order>7</order></author><author><firstname>Rachel</firstname><surname>Still</surname><order>8</order></author><author><firstname>Jenna A</firstname><surname>Walters</surname><order>9</order></author><author><firstname>Non</firstname><surname>Gwynn</surname><order>10</order></author><author><firstname>Wilson</firstname><surname>Chea</surname><order>11</order></author><author><firstname>Rachel</firstname><surname>Harford</surname><order>12</order></author><author><firstname>Claire</firstname><surname>O'Neill</surname><order>13</order></author><author><firstname>Julie</firstname><surname>Hepburn</surname><order>14</order></author><author><firstname>Ian</firstname><surname>Hill</surname><order>15</order></author><author><firstname>Heather</firstname><surname>Wilkes</surname><order>16</order></author><author><firstname>Greg</firstname><surname>Fegan</surname><order>17</order></author><author><firstname>Peter</firstname><surname>Dunstan</surname><orcid>0000-0002-4337-4307</orcid><order>18</order></author><author><firstname>Dean</firstname><surname>Harris</surname><orcid>0000-0003-2673-8946</orcid><order>19</order></author></authors><documents><document><filename>63168__27063__c4bca163f21940669f0e52dd0d1b169c.pdf</filename><originalFilename>63168.pdf</originalFilename><uploaded>2023-04-17T10:28:51.6612135</uploaded><type>Output</type><contentLength>1065436</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 63168 2023-04-17 A novel blood based triage test for colorectal cancer in primary care: a pilot study eada15d4d33fcb3dfddcff43f1323bd6 0000-0002-4337-4307 Peter Dunstan Peter Dunstan true false 731533890c5123febe4f65dffd369f7b 0000-0003-2673-8946 Dean Harris Dean Harris true false 2023-04-17 SPH Background: The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is a pressing need for access to simple triage tools in primary care to help prioritise patients for referral. Aim: To evaluate the performance of a novel spectroscopy-based CRC blood test in primary care. Design & setting: Mixed-methods pilot study of test performance and GP focus group discussions in South Wales. Method: Patients on the urgent suspected cancer (USC) pathway were recruited for the Raman spectroscopy (RS) test coupled to machine learning classification (‘Raman-CRC’) to identify CRC within the referred population. Qualitative focus group work evaluated the acceptability of the test in primary care by thematic analysis of focus group theorising. Results: A total of 532 patients aged ≥50 years referred on the USC pathway were recruited from 27 GP practices. Twenty-nine patients (5.0%) were diagnosed with CRC. Raman-CRC identified CRC with sensitivity 95.7%, specificity 69.3% with area under curve (AUC) of 0.80 compared with colonoscopy as the reference test (248 patients). Stage I and II cancers were detected with 78.6% sensitivity. Focus group themes underlined the convenience of a blood test for the patient and the test’s value as a risk assessment tool in primary care. Conclusion: The findings support this novel, non-invasive, blood-based method to prioritise those patients most likely to have CRC. Raman-CRC may accelerate access to diagnosis with potential to improve cancer outcomes. Journal Article BJGP Open 7 1 BJGPO.2022.0077 Royal College of General Practitioners 2398-3795 colorectal neoplasms, two-week waitpilot projects, qualitative research, Raman spectroscopy, primary health care, general practice 1 3 2023 2023-03-01 10.3399/bjgpo.2022.0077 http://dx.doi.org/10.3399/bjgpo.2022.0077 COLLEGE NANME Physics COLLEGE CODE SPH Swansea University 2023-05-18T14:07:14.0128819 2023-04-17T10:24:24.0778764 Faculty of Science and Engineering School of Biosciences, Geography and Physics - Physics Cerys Jenkins 1 Freya Woods 2 Susan Chandler 3 Kym Carter 4 Rhys Jenkins 5 Andrew Cunningham 6 Kayleigh Nelson 7 Rachel Still 8 Jenna A Walters 9 Non Gwynn 10 Wilson Chea 11 Rachel Harford 12 Claire O'Neill 13 Julie Hepburn 14 Ian Hill 15 Heather Wilkes 16 Greg Fegan 17 Peter Dunstan 0000-0002-4337-4307 18 Dean Harris 0000-0003-2673-8946 19 63168__27063__c4bca163f21940669f0e52dd0d1b169c.pdf 63168.pdf 2023-04-17T10:28:51.6612135 Output 1065436 application/pdf Version of Record true This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/) true eng http://creativecommons.org/licenses/by/4.0/
title A novel blood based triage test for colorectal cancer in primary care: a pilot study
spellingShingle A novel blood based triage test for colorectal cancer in primary care: a pilot study
Peter Dunstan
Dean Harris
title_short A novel blood based triage test for colorectal cancer in primary care: a pilot study
title_full A novel blood based triage test for colorectal cancer in primary care: a pilot study
title_fullStr A novel blood based triage test for colorectal cancer in primary care: a pilot study
title_full_unstemmed A novel blood based triage test for colorectal cancer in primary care: a pilot study
title_sort A novel blood based triage test for colorectal cancer in primary care: a pilot study
author_id_str_mv eada15d4d33fcb3dfddcff43f1323bd6
731533890c5123febe4f65dffd369f7b
author_id_fullname_str_mv eada15d4d33fcb3dfddcff43f1323bd6_***_Peter Dunstan
731533890c5123febe4f65dffd369f7b_***_Dean Harris
author Peter Dunstan
Dean Harris
author2 Cerys Jenkins
Freya Woods
Susan Chandler
Kym Carter
Rhys Jenkins
Andrew Cunningham
Kayleigh Nelson
Rachel Still
Jenna A Walters
Non Gwynn
Wilson Chea
Rachel Harford
Claire O'Neill
Julie Hepburn
Ian Hill
Heather Wilkes
Greg Fegan
Peter Dunstan
Dean Harris
format Journal article
container_title BJGP Open
container_volume 7
container_issue 1
container_start_page BJGPO.2022.0077
publishDate 2023
institution Swansea University
issn 2398-3795
doi_str_mv 10.3399/bjgpo.2022.0077
publisher Royal College of General Practitioners
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Biosciences, Geography and Physics - Physics{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Biosciences, Geography and Physics - Physics
url http://dx.doi.org/10.3399/bjgpo.2022.0077
document_store_str 1
active_str 0
description Background: The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is a pressing need for access to simple triage tools in primary care to help prioritise patients for referral. Aim: To evaluate the performance of a novel spectroscopy-based CRC blood test in primary care. Design & setting: Mixed-methods pilot study of test performance and GP focus group discussions in South Wales. Method: Patients on the urgent suspected cancer (USC) pathway were recruited for the Raman spectroscopy (RS) test coupled to machine learning classification (‘Raman-CRC’) to identify CRC within the referred population. Qualitative focus group work evaluated the acceptability of the test in primary care by thematic analysis of focus group theorising. Results: A total of 532 patients aged ≥50 years referred on the USC pathway were recruited from 27 GP practices. Twenty-nine patients (5.0%) were diagnosed with CRC. Raman-CRC identified CRC with sensitivity 95.7%, specificity 69.3% with area under curve (AUC) of 0.80 compared with colonoscopy as the reference test (248 patients). Stage I and II cancers were detected with 78.6% sensitivity. Focus group themes underlined the convenience of a blood test for the patient and the test’s value as a risk assessment tool in primary care. Conclusion: The findings support this novel, non-invasive, blood-based method to prioritise those patients most likely to have CRC. Raman-CRC may accelerate access to diagnosis with potential to improve cancer outcomes.
published_date 2023-03-01T14:07:12Z
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