They say a tree falling in a forest, but with no-one to hear it, makes no sound. Well maybe, though I\u2019ve always doubted it. What\u2019s clear is that medical research, if it doesn\u2019t change practice, makes no sound. In this spirit was a conference in London last month.<\/p>\n\n\n\n
I co-led a successful HTA research bid three years, with Sarah Bailey and Gary Abel as co-applicants, alongside a host of other colorectal cancer luminaries. This grant was to see if we can improve the prediction power of colorectal cancer in patients whose symptoms suggest cancer is a possibility. Currently, there is a test called faecal immunochemical testing (or FIT, which allows all sorts of duff puns, that I\u2019ll avoid). This FIT test identifies haemoglobin in the stool, the idea being that colorectal cancers leak blood into the stool. The test works \u2013 as the Exeter team (and others) have shown. But can it be improved? At present, there\u2019s a single cutoff, 10mg haemoglobin\/g faeces, to define a \u2018positive\u2019 test \u2013 and thus to trigger a colonoscopy. Age isn\u2019t considered, gender isn\u2019t considered, other symptoms aren\u2019t considered\u2026..<\/p>\n\n\n\n
So, we wanted to see if other variables improved the prediction beyond the simple use of FIT alone. We did a systematic review https:\/\/doi.org\/10.1016\/j.eclinm.2023.102204 which showed lots of people had done small studies, though none of the algorithms\/equations had been successfully validated in another population.<\/p>\n\n\n\n
We then created a new algorithm from a huge Nottingham dataset, having tried in a smaller Exeter\/Sheffield dataset. It included age, sex, FIT, and two things from a simple blood test \u2013 platelets (an Exeter speciality https:\/\/www.mdpi.com\/2072-6694\/16\/17\/3074), and MCV (if you know what that is, take a bow and a chocolate biscuit). It seemed to work https:\/\/doi.org\/10.1111\/apt.18459. We then tested it in three other datasets (a later Nottingham one, an Oxford one, and one from NW England). IT WORKED!<\/p>\n\n\n\n
We did a health-economic study (almost accepted) and two patient\/practitioner qualitative studies (the latter also almost accepted, asking the question \u2018are patients happy with an algorithm dictating whether they proceed to colonoscopy: answer \u2013 maybe!).<\/p>\n\n\n\n
All sounds good: now to tell the world. We invited \u2018the great and the good\u2019 particularly targeting NHSE (as they have the NHS chequebook, so to speak), but with a good number of patient reps (to keep us on our toes \u2013 thank you!) and academics (to ask us difficult questions \u2013 what\u2019s new?).<\/p>\n\n\n\n
IT WORKED! I say this because we got genuine dialogue with the whole audience. Of course, we\u2019d kept NHSE and NICE etc., in the loop (tip: do this as much and as often as you can). There were remaining problems\u2026could we be sure the apparent 17% reduction in colonoscopies but no fewer cancers found would actually happen if we went live? Would we miss other conditions, like inflammatory bowel disease? Who would get MHRA approval? [ this last is a really tiresome<\/p>\n\n\n\n
process, originating from some wiseacre deciding medical equations were medical devices \u2013 like a pacemaker, or artificial hip so needed to jump a million hoops for approval].<\/p>\n\n\n\n
At the end of the day, there was a feeling of \u2018we\u2019ve done our best as researchers \u2013 now it\u2019s over to policymakers,\u2019 but we were actually delighted to be green-lighted by NHSE (and to get off the hook of our having to get MHRA approval).<\/p>\n\n\n\n
The message? End of programme events are good. As ever, they require preparation, but the end result should be better colorectal cancer services for all, in that the 17% reduction in scopes means the 83% get it more quickly, the 17% don\u2019t have the worry of a colonoscopy (or the ghastly preparation for colonoscopy), the colonoscopists actually get time to draw breath between cases, and taxpayers save a little bit of NHS dosh.<\/p>\n","protected":false},"excerpt":{"rendered":"
They say a tree falling in a forest, but with no-one to hear it, makes no sound. Well maybe, though I\u2019ve always doubted it. What\u2019s clear is that medical research, if it doesn\u2019t change practice, makes no sound. In this spirit was a conference in London last month. I co-led a successful HTA research bid […]<\/p>\n","protected":false},"author":989,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[43],"tags":[],"acf":[],"yoast_head":"\n