GPs refer Eighty per cent of suspected Cancers after two visits

MORE THAN eighty per cent of patients suspected of having cancer are being referred by their GP in the first two consultations, with more than half being sent to see a specialist at the first appointment, according to new research published in the British Journal of Cancer today (Friday).

A group of researchers from the universities of Cambridge, Durham and Bangor looked at data from over 13,000 patients in order to measure the promptness of cancer diagnosis in primary care. They found that 82 per cent of people were referred after two visits, with over half of patients (58 per cent) referred to a specialist after the first visit.

The study has also revealed that some cancers are proving harder to spot in the first few consultations, such as lung cancer and myeloma. This may be because they often produce symptoms that are common and not unique to cancer, so can be mistaken for less serious conditions.

The findings show that, the more consultations a patient needs, the greater number of weeks between first presentation and referral. With most of the patients who have these harder-to-spot cancers, it takes longer before there is a suspicion of cancer and they are seen by hospital specialists.

Dr Georgios Lyratzopoulos, study author and National Institute for Health Research post-doctoral research fellow working at the Cambridge Centre for Health Services Research, said: “These results show the progress we’re making in spotting cancer at the earliest opportunity. We now understand the typical symptoms of some cancers, like breast and melanoma, very well and that helps doctors to spot them quickly.

“Other cancers have less typical symptoms, making them more difficult to recognise straight away. Not suspecting cancer early enough can be stressful for patients and their relatives so understanding the symptoms of these cancers better is where we need to be making greater research efforts to help spot the disease earlier.”

Last year, the Royal College of General Practitioners (RCGP), in partnership with Cancer Research UK, launched a five-year programme to improve early diagnosis of cancer in general practice.

Professor Greg Rubin, the RCGP and Cancer Research UK clinical lead for cancer* and co-author of the research, said: “We’ve found that most patients who go to their GP with cancer symptoms are being promptly referred to a specialist. NICE referral guidelines have helped people with classic symptoms to be seen more quickly but, for patients with less typical symptoms, the decision to refer isn’t always as simple.

“Reducing the number of pre-referral consultations can result in a more timely diagnosis of cancer. We need to consider ways of making the process of primary care assessment even smarter, for instance by wider use of clinical decision support tools or more efficient investigation pathways.”

Sara Hiom, early diagnosis director at Cancer Research UK, said: “These findings are encouraging but there is still room for improvement. Progress is clearly being made but one in five people have to make more than two visits to their GP, although it’s not surprising that this is usually for those cancers that are harder to spot. And we know for some people, difficulty making an appointment can be a barrier to going to the GP in the first place.

“Cancer can be treated more effectively when diagnosed early, so we need to make every effort to support GPs in getting the disease consistently diagnosed more quickly and accurately. But it’s also important that we all act on any persistent health changes that concern us and have the confidence to go back to our GPs if problems don’t clear up after an initial visit.”

Professor Richard Neal from Bangor University’s North Wales Centre for Primary Care Research, and one of the co-authors of the study, said:

“One of the key findings from this research is the continued need to focus on the timely and efficient diagnosis of cancer – one of the key aims of the Welsh Government’s Cancer Delivery Plan. In particular we need to focus on the ‘difficult-to-suspect’ cancers. For example, in this study, the two cancers that have the most GP consultations prior to being referred to see a specialist (and with the longest intervals between seeing a GP and referral) are multiple myeloma and lung cancer. Our future research here in north Wales will be focusing on these cancers.’

Publication date: 8 February 2013