An important review of 215,284 patients suffering with cancer has been published in the British Medical Journal. The study was funded by Cancer Research UK and National Institute of Health Research.
One of the conclusions is that 2,400 patients suffering from cancer die needlessly every year due to failures by GPs in referring patients with suspicious symptoms.
Currently, in the NHS system, a patient should be seen by a specialist hospital and doctor within two weeks of a GP identifying symptoms which are suspicious of cancer. This is called the 'Two-week wait'.
The study showed that the death rates increased by 7% for patients whose GP practices used the Two-Week Wait least often compared with practices which adhere to the "Two-Week Wait" system
The data was gathered from 8,049 general practices in England where patients were diagnosed or first treated in 2009 and followed up to 2013.
NICE guidelines on GP referrals
The new NICE referral guidelines for suspected cancer which were published in June this year[1], replacing the 2005 guidelines, aim to provide more guidance for GPs on when to refer patients. The guidelines aim to lower the referral threshold, so that more referrals can be made and patients can be seen sooner. It is better to make an unnecessary referral than to miss a cancer.
GPs are now able to make "very urgent" referrals. In such cases the patient should be seen by a cancer specialist within 48 hours of the GP suspecting signs or symptoms of cancer.
The NICE guidelines also aim to provide GPs with guidance on what symptoms may be relevant to specific types of cancer and which symptoms should result in a "very urgent" or "two week wait" referral being triggered.
NICE hope that the guidelines will lead to a significant increase in referrals, which will no doubt have cost and capacity implications for oncology services. On the plus side an increase in referrals at an early stage may also have wider benefits such as lower treatment costs for patients diagnosed earlier and less frequent emergency presentations. Most importantly, it may lead to a reduction in death rates due to delayed diagnosis.
Currently, every 1 in 4 cancer patient is diagnosed through an emergency admission to the hospital. Not only does this create pressures on the specialists but it is also likely that most of these diagnoses are not of cancer in its early stages.
Correlation between earlier diagnosis and survival rates
It is widely accepted that diagnosing cancer in the early stages gives the patient a better survival chance. Cancer Research UK has highlighted the following statistics:-
Bowel Cancer – More than 9 in 10 bowel cancer patients will survive the disease for more than 5 years if diagnosed at the earliest stage.
Breast Cancer – More than 90% of women diagnosed with breast cancer at the earliest stage survive their disease for at least 5 years compared to around 15% for women diagnosed with the most advanced stage of disease.
Ovarian Cancer - More than 90% of women diagnosed with the earliest stage ovarian cancer survive their disease for at least 5 years compared to around 5% for women diagnosed with the most advanced stage of disease.
Lung Cancer - Around 70% of lung cancer patients will survive for at least a year if diagnosed at the earliest stage compared to around 15% for people diagnosed with the most advanced stage of disease.
As well as better survival rates, earlier diagnosis may also mean a less intensive treatment programme.
Symptoms to look out for and to report
Symptoms that you should be looking out for:-
- Unusual lump or swelling
- Unexplained pain or ache
- Persistent cough
- Coughing up blood
- Changes in bowel habits
- Unexplained vaginal/anal bleeding
- Persistent heartburn or indigestion
- Breathlessness
- Unexplained weight loss
- New mole or changes to a mole
A more extensive list and further information can be found on the Cancer Research UK website: http://www.cancerresearchuk.org/
Fieldfisher have pursued a number of cases for patients who sadly have suffered death or additional injury as a result of delay in referral to a specialist doctor by a GP.
By Nilam Patel, Paralegal