Date: 13 February 2019
Western Sussex Hospitals NHS Foundation Trust (WSHT) recently won an award for being the ‘Top Recruiter’ for the Saliva to Predict risk of disease using Transcriptomics and epigenetics (SPIT) study. As of 14 January 2019 they have recruited 117 participants from St Richard's Hospital in Chichester and Worthing Hospital, exceeding their projected target. The overall national target is 1000.
The SPIT study aims to assess whether the characteristics of patients’ saliva, in combination with symptoms and other risk factors, can accurately predict the presence of oesophageal cancer. Colorectal cancer will also be looked at in the future.
Currently there is no effective screening test for oesophageal cancer and before a diagnosis can be made, most patients with suspicious symptoms undergo an endoscopy. This is where a thin flexible lighted instrument with a camera at the end is passed through the mouth into the oesophagus.
Invasive tests like endoscopies are often uncomfortable and inconvenient for patients, and very costly for the NHS as many of these tests come out with ‘normal results’. This is because only a small percentage of patients being investigated actually have the disease.
There are two separate parts to the SPIT study. One part of the study recruits patients, who are waiting to undergo an endoscopy to diagnose or exclude the disease, to answer an electronic questionnaire. The questionnaire obtains information regarding the patient’s symptoms, and tests which questions would be relevant to ask in order to avoid patients having to have invasive tests unnecessarily.
The second section of the study asks participants to complete the same questionnaire in addition to providing saliva, blood samples and oesophageal biopsies. This set of patients need to match a particular criteria before they can be asked whether they would consider taking part. This includes patients who are already known to have oesophageal disease such as Barretts’ oesophagus. Future research on the SPIT study will include patients with colorectal disease. The study criteria asks the study team to recruit participants from a range of ages, genders and ethnic backgrounds.
Genetic analysis is performed on the saliva and blood samples to see if the characteristics of the patients’ saliva in combination with symptoms and other risk factors can accurately predict cancer. The saliva test results are compared with the blood and, where possible, biopsy test results.
Research nurses Susanna Greenslade and Yvette Thirlwall explained their approach to recruiting participants to the study:
“We have a comprehensive recruitment plan whereby we make sure that we approach patients at the most appropriate time and in a way which is sensitive to their needs at that stage of the journey. This involves working in outpatient clinics, attending MDT meetings and working closely with our consultant colleagues who refer patients to us. We approach patients in clinic, or phone them to speak to them about the study. If the patient agrees we then offer to send them more information by email or by post. We ensure that they have had enough time to consider participation prior to their endoscopy.”
Cate Bell, Head of Research at Western Sussex Hospitals NHS Foundation Trust says: “It’s fantastic that all the team’s hard work for the SPIT trial has been recognised nationally and it’s a great achievement to be top recruiter in the UK. It also shows how our commitment to increasing research opportunities for patients at Western Sussex Hospitals is contributing to improving care for all NHS patients.”
Nicola Southwell, National Institute for Health Research (NIHR) Clinical Research Network for Kent, Surrey and Sussex Research Delivery Manager for Cancer says: “The careful planning undertaken by the team at the outset has clearly led to this impressive recruitment. It is also fantastic to see the sensitivity afforded to the best time to approach patients, keeping their interests at the top of the agenda. This success demonstrates the value of good working relationships with clinicians and the selection of a study supported by the whole team. WSHFT generously offered to share their planning tool with other trusts and it would be great to see this achievement spread across the network. The study is due to close in March 2020.”
Once accuracy of these tests are confirmed, the aim is for the creation of a cheap, portable and quick bedside test that uses patients’ saliva to predict their risk of disease, so that only high-risk patients can be scheduled to undergo further investigations.
This will save the NHS and other healthcare systems worldwide significant amounts of money, while saving patients across the world time, inconvenience and reducing their risk of complications from unnecessary investigations.
The study is also well underway at Frimley Park Hospital in Surrey and The Royal Surrey County Hospital in Guildford.
Research nurses, Yolanda Baird, Julie Wheatley and Yvette Thirlwall with Nurse Endoscopist Xerxes Lintag and Claire Dumbrell, Sister in the Endoscopy Unit.
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