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Colorectal Cancer (Diagnosis)NCT07430527

Secondary Care Colorectal Cancer Pathway Review

An observational study of Colorectal Cancer (Diagnosis), run by University of Edinburgh at 2 sites in United Kingdom.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Bowel cancer (colorectal cancer) is the 4th most common cancer in Scotland. Approximately 4,000 cases are diagnosed annually. Cancer-related deaths in Scotland are higher than other UK nations. Improving the early detection of bowel cancer, and therefore survival, is important. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Colorectal Cancer (Diagnosis)
What is being tested?
Faecal Immunohistochemical test
How many people
25,000 participants
Where
2 sitesUnited Kingdom
Study dates
6 May 2026to 31 Aug 2030
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Adults referred to secondary-care with 'red-flag' gastrointestinal symptoms concerning for CRC.

Who may be able to join

  • Patients managed within the NHS Lothian CRC USoC/urgent pathway (including urgent referrals) due to 'red-flag' symptoms concerning of CRC from April 2022 to August 2025.

Who cannot join

  • Under the age of 18.
  • History of inflammatory bowel disease.
  • Under polyp surveillance.
  • Previous diagnosis of CRC.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

United Kingdom2 sites, 2 recruiting
  • NHS Lothian

    Edinburgh

    Not yet recruiting
  • NHS Lothian

    Edinburgh

    Farhat Din, 01316518500, Farhat.Din@ed.ac.uk

    Recruiting

Other trials in United Kingdom

About this study

Official title: A Retrospective Review of the Secondary-care Colorectal Cancer Pathway Within NHS Lothian: An Evaluation of 3 Years of Pathway Performance

Bowel cancer (colorectal cancer) is the 4th most common cancer in Scotland. Approximately 4,000 cases are diagnosed annually. Cancer-related deaths in Scotland are higher than other UK nations. Improving the early detection of bowel cancer, and therefore survival, is important.

The majority of bowel cancers are diagnosed within secondary-care (colorectal surgery unit). Upon GP referral to secondary-care, patients provide stool samples which are analysed for microscopic blood (FIT; faecal immunohistochemical test). Patients with a single positive result are more likely to have bowel cancer (0.2% risk if no blood detected, but 8.4% if detected). A positive test triggers further investigation, either CT scan or colonoscopy depending on the result. Currently, colonoscopy and radiology services throughout Scotland are under significant pressure causing delays.

Read more

Only 2% of patients referred to secondary-care are diagnosed with bowel cancer, and most colonoscopies performed do not yield significant findings. We have shown that performing two repeated FITs upon referral improves cancer pickup rate (sensitivity) and reduces missed cancers. We successfully implemented this in NHS Lothian and contributed to national guidelines.

This study will undertake a comprehensive retrospective review of the double-FIT urgent suspicion of bowel cancer pathway within NHS Lothian, from April 2022 (date of pathway inception) to August 2025, including around 25,000 patients that have been managed through the pathway. We will calculate key performance indicators and diagnostic accuracy of the pathway. Health economic analysis will determine cost-per-diagnosis. Risk factors for bowel cancer in this patient cohort will be identified to develop a support tool for primary and secondary-care. These results will be used to develop a future pathway to optimise pathway efficiency and cancer detection.

Read the detailed description

Design:

This is a retrospective observational cohort data-analysis study of patients managed within the NHS Lothian colorectal cancer (CRC) urgent suspicion of cancer (USoC) pathway and patients referred urgently to the Colorectal department from April 2022 to August 2025. April 2022 corresponds to the start of double FIT testing within the pathway. 5-year follow-up will be included (up to August 2030) to include 5-year cancer outcomes.

Methods:

Patients will be identified from our pathway. Estimated ~25,000 patients will be included. Data will be collected on patient characteristics, past medical and prescribing history, hospital presentations and investigation outcomes, cancer outcomes and mortality data. Linkage to relevant patient datasets will be required.

A service review of the USoC/urgent pathway will focus on key performance indicators such as time to diagnosis and treatment, as well as patient journey pathways (Sankey plots) and re-referral rates.

Furthermore, data will be analysed using standard methods such as odds-ratio multivariate logistic regression to determine any significant associations which enrich for CRC and significant bowel pathology in this patient group. Significant bowel pathology includes advanced adenoma, advanced colorectal neoplasia and inflammatory bowel disease (IBD). Importantly, the modelling will only utilise readily available information from the electronic health record (EHR) such as age, sex, blood haemoglobin, BMI and SIMD to improve pre-test probability by restricting the target population.

Markov models will be formed as part of the health economic analysis, and the financial cost per case detected within the pathway will be calculated. We will explore the impact of waiting times on disease progression and the associated impact on the financial costs of treatment and patient quality of life.

Results from the above analyses will be incorporated into a decision-flow as guidance for referrals to secondary-care.

Sample size calculation:

To perform regression analysis, at a significance level of 0.05, medium size effect and 10 predictors, 170 cases of CRC are required. Our database of ~25,000 patients has approximately 500 cases of CRC. There will be minimal anticipated drop-out. Therefore our required sample size will be achievable.22

Proposed analyses:

Standard summary statistics of the pathway will be reported (means, standard deviations, medians, inter-quartile range). Multivariate logistic regression will be performed to determine risk-factors significant for CRC at different FIT levels. Subgroup analyses will take place within different FIT result thresholds (<10, 10-79, >79 µgHb/g) as well as between cancer and non-cancer patients, and for other significant bowel pathology. Long-term outcome data will be analysed, up to 5 years.

Furthermore, a service evaluation of the USoC/urgent pathway will focus on key performance indicators such as time to diagnosis and treatment, as well as patient journey pathways (Sankey plots) and re-referral rates. Markov models will be formed as part of the health economic analysis, and the financial cost per case detected within the pathway will be calculated. We will explore the impact of waiting times on disease progression and the associated impact on the financial costs of treatment and patient quality of life. The rate of interval cancers over long-term follow-up will be calculated.

We do not anticipate a significant amount of missing data. Data entries will be removed due to missing data on an analysis-by-analysis basis.

Being tested
Faecal Immunohistochemical test
Keywords
Faecal immunohistochemical test, FIT
Medical subject headings
Colorectal Neoplasms, Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Faecal Immunohistochemical testDiagnostic test

    Faecal Immunohistochemical test

Study groups in NCT07430527
Study groupRoleWhat they receive
FIT non-returnersReferred patients who did not return FIT
Single FIT returnersReferred patients who returned a single FIT
Receives: Diagnostic Test: Faecal Immunohistochemical test
Double FIT returnersReferred patients who returned two FITs
Receives: Diagnostic Test: Faecal Immunohistochemical test

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pathway diagnostic accuracy

    Sensitivity, specificity, NNI of pathway

    Measured: 1 year

Secondary outcomes (1)
  1. Cost per diagnosis

    Cost per CRC diagnosis

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Feb 2026
  2. Study start6 May 2026
  3. Primary completion31 Aug 2027 (estimated)
  4. Study completion31 Aug 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
25,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07430527
Sponsor's protocol ID
AC26020
Status last verified
Aug 2026
First submitted
18 Feb 2026
Last updated
28 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There is no plan to share IPD due to patient numbers and confidentiality

Publications

  • Perkmann T, Koller T, Perkmann-Nagele N, Ozsvar-Kozma M, Eyre D, Matthews P, Bown A, Stoesser N, Breyer MK, Breyer-Kohansal R, Burghuber OC, Hartl S, Aletaha D, Sieghart D, Quehenberger P, Marculescu R, Mucher P, Radakovics A, Klausberger M, Duerkop M, Holzer B, Hartmann B, Strassl R, Leitner G, Grebien F, Gerner W, Grabherr R, Wagner OF, Binder CJ, Haslacher H. Increasing test specificity without impairing sensitivity: lessons learned from SARS-CoV-2 serology. J Clin Pathol. 2023 Nov;76(11):770-777. doi: 10.1136/jcp-2022-208171. Epub 2022 Aug 30.

    PubMed 36041815
  • Cubiella J, Vega P, Salve M, Diaz-Ondina M, Alves MT, Quintero E, Alvarez-Sanchez V, Fernandez-Banares F, Boadas J, Campo R, Bujanda L, Clofent J, Ferrandez A, Torrealba L, Pinol V, Rodriguez-Alcalde D, Hernandez V, Fernandez-Seara J; COLONPREDICT study investigators. Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients. BMC Med. 2016 Aug 31;14(1):128. doi: 10.1186/s12916-016-0668-5.

    PubMed 27580745
  • Gerrard AD, Maeda Y, Miller J, Gunn F, Theodoratou E, Noble C, Porteous L, Glancy S, MacLean P, Pattenden R, Dunlop MG, Din FVN; Edinburgh Colorectal Group. Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer. Br J Surg. 2023 Mar 30;110(4):471-480. doi: 10.1093/bjs/znad016.

    PubMed 36785496
  • Saw KS, Liu C, Xu W, Varghese C, Parry S, Bissett I. Faecal immunochemical test to triage patients with possible colorectal cancer symptoms: meta-analysis. Br J Surg. 2022 Feb 1;109(2):182-190. doi: 10.1093/bjs/znab411.

    PubMed 34907419
  • Pin-Vieito N, Tejido-Sandoval C, de Vicente-Bielza N, Sanchez-Gomez C, Cubiella J. Faecal immunochemical tests safely enhance rational use of resources during the assessment of suspected symptomatic colorectal cancer in primary care: systematic review and meta-analysis. Gut. 2022 May;71(5):950-960. doi: 10.1136/gutjnl-2021-324856. Epub 2021 Jun 9.

    PubMed 34108236
  • Bailey JA, Ibrahim H, Bunce J, Chapman CJ, Morling JR, Simpson JA, Humes DJ, Banerjea A. Quantitative FIT stratification is superior to NICE referral criteria NG12 in a high-risk colorectal cancer population. Tech Coloproctol. 2021 Oct;25(10):1151-1154. doi: 10.1007/s10151-021-02466-z. Epub 2021 Jul 14.

    PubMed 34263362
  • Cubiella J, Salve M, Diaz-Ondina M, Vega P, Alves MT, Iglesias F, Sanchez E, Macia P, Blanco I, Bujanda L, Fernandez-Seara J. Diagnostic accuracy of the faecal immunochemical test for colorectal cancer in symptomatic patients: comparison with NICE and SIGN referral criteria. Colorectal Dis. 2014 Aug;16(8):O273-82. doi: 10.1111/codi.12569.

    PubMed 24456168
  • Farkas N, O'Brien JW, Palyvos L, Maclean W, Benton S, Rockall T, Jourdan I. The increasing burden of the 2-week wait colorectal cancer pathway in a single centre: the impact of faecal immunochemical tests. Ann R Coll Surg Engl. 2024 Apr;106(4):338-343. doi: 10.1308/rcsann.2022.0138. Epub 2023 Jan 23.

    PubMed 36688865
  • Lemmon E, Hanna C, Diernberger K, Paterson HM, Wild SH, Ennis H, Hall PS. Variation in colorectal cancer treatment and outcomes in Scotland: real world evidence from national linked administrative health data. Int J Popul Data Sci. 2024 Feb 20;9(1):2179. doi: 10.23889/ijpds.v6i1.2179. eCollection 2024.

    PubMed 38476269

Questions about this trial

What is this clinical trial studying?

An observational study of Colorectal Cancer (Diagnosis), run by University of Edinburgh at 2 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 28 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pathway diagnostic accuracy (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07430527, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Aug 2026.

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