C THE SIGNS VISITS NO. 10 AND THE NHS LONG TERM PLAN

In December, C the Signs visited 10 Downing Street to discuss the impact C the Signs has been having and how it can improve the early diagnosis of cancer. This week we welcome the publication of NHS England’s much awaited Long Term Plan to tackle the challenges the NHS is going to face in the coming years. Here we take a look at the cancer priorities and what it means for primary care.

BE THE MOTIVATION YOUR PATIENTS NEED TO QUIT SMOKING THIS NEW YEAR

As 2019 begins I am sure many of us will be setting ‘New Year’s resolutions’, as will be the case for many of your patients. Quitting smoking is one of the most popular health-related resolutions, but also one of the least successful, with the Royal Society for Public Health reporting quitting smoking to be the most difficult resolution to keep (and by some margin). In the New Year of 2016, of those who resolved to quit smoking, 3 in 5 were smoking again by the end of January 2016 and just 13% had stuck to their resolution by the end of the year.

Make Every Contact Count – Tackling Obesity

Obesity is the second biggest preventable cause of cancer in the UK, with Cancer Research UK reporting that more than 1 in 20 cancer cases are caused by excess weight. The risk increases with the more weight a person gains and the longer they are overweight for. Yet small changes that are maintained long-term can make a significant difference. Making every contact count (MECC) is an approach to behaviour change that utilises daily interactions to encourage others to make a behaviour change which would have a positive effect on health. This is an important initiative run by NHS Health Education England which can be implemented by GPs to encourage patients to lose weight.

Cases corner – 19 YEARS OLD WITH LYMPHADENOPATHY

Mr X, a 19 year old man, presents to you with a one week history of lumps in his groin. He is otherwise well, denying any fever, sore throat, appetite loss, pain, urethral discharge, urinary frequency or dysuria. On examination you note generalised lymphadenopathy (cervical, axilla and groin). There is no evidence of pharyngitis and his spleen is not palpable.

What would you do next?

  1. Reassure him and offer safety-netting advice if he deteriorates
  2. Request a very urgent full blood count
  3. Request an urgent blood film
  4. Refer the patient along a 2-week-wait pathway to haematology
  5. Refer the patient immediately to hospital

Loneliness this Christmas

In 2016, approximately 400,000 people with cancer in the UK reported feeling lonely over the festive period. MacMillan Cancer Support reported that 16% of cancer patients felt that the Christmas and New Year period was one of the loneliest times of the year, equalling that of the anniversary of the death of a loved one.

Several factors may contribute to feelings of loneliness among people living with cancer over Christmas, but there is support available for these people over the festive period.

Read about why this time of year can be particularly lonely and some examples of support to recommend to your patients.

Shining a light on – Samaritans

For more than 60 years, Samaritans volunteers have been there for anyone who is struggling. During December 2017, Samaritans responded to more than 400,000 calls for help by phone, email and text throughout the UK and Ireland. Despite the festivities, more than 11,000 of those calls for help and emotional support came in on Christmas Day, with a third dealing with loneliness and isolation.

Samaritans volunteers will be making sure there’s a listening ear day and night again this year for anyone who’s feeling overwhelmed and needs to talk, throughout the festive period.

Cases corner – 8 year old boy with a rash

An 8 year old boy presents to you with his mum, with a 2-day history of a spreading rash over his lower limbs. He is otherwise well with no other symptoms. There is no evidence of confusion, neck stiffness, photophobia or fever. He has previously been fit and well and is up to date with his immunisations. His observations are all within the normal range. You examine his lower legs and see the following rash on his feet and legs. Otherwise, the examination is unremarkable.

What would you do next?

  1. Reassure his mum and offer safety-netting advice if he deteriorates
  2. Refer the patient for an urgent full blood count (within 48 hours)
  3. Refer the patient for a full blood count (within 2 weeks)
  4. Consider urgently referring the patient to a specialist within 48 hours
  5. Refer the patient immediately to hospital

GPs need to be encouraged to become gate openers rather than asked to be gate keepers

On Tuesday 4th December, C the Signs was invited to present at the Britain Against Cancer 2018 Conference, hosted by the All Party Parliamentary Group on Cancer. C the Signs outlined the challenge GPs face in primary care with rising demand and the pressure they are under as gatekeepers, the need for better straight to test pathways and why GPs aren’t the barrier to early diagnosis.

Shining a light on – BOOBS!

CoppaFeel! is an education charity on a mission to educate young people on the signs and symptoms of breast cancer, encourage them to get to know their boobs/pecs and empower them to visit their GP if they spot something abnormal.

“I have lost count of the number of times I have heard a woman say that her GP kept telling her that she was ‘too young’ to have womb cancer”

On 23rd December 2009, I was diagnosed with womb cancer. The diagnosis came out of the blue. I was being seen by a gynaecologist for fibroids when an MRI scan picked up the cancer. I had never heard of “endometrial carcinoma” and actually had to ask where exactly the cancer was. I know now that this happens to many other women.

Cases corner – 50 years old with thrombocytosis

Mr D, a 50 year old man, attends for his annual health check. He is currently fit and well and his examination is unremarkable. A urine dipstick is negative. You perform routine bloods as part of your assessment. The results of this show an abnormal platelet count of 620 x10⁹/L. His previous blood test 6 months ago, was normal. A repeat 2 weeks later is also raised at 624 x10⁹/L.

What would you do next?

  1. Reassure, as patient is asymptomatic, and safety net if symptoms arise to comeback
  2. Re-book patient for a repeat platelet count in 3 months
  3. Refer for a chest x-ray
  4. Refer under a 2-week-wait pathway to haematology for further investigation

Shining a Light on – Pancreatic Cancer Action

Pancreatic cancer is the 5th biggest cause of cancer death in the UK. However, it is set to become the 4th biggest by 2026 as other cancers’ survival rates continue to improve. The survival statistics for pancreatic cancer have not changed significantly in nearly 50 years, with less than 7% surviving 5 years. Pancreatic Cancer Action is the only UK charity that specifically focuses on early diagnosis of the disease.

"I went to the GP that morning with non-specific symptoms and I was admitted to hospital that night with a confirmed diagnosis of Chronic Myeloid Leukaemia"

On Friday 19th January 2007 I received a phone call that would change everything. I went to the GP that morning with non-specific symptoms including lack of concentration, weight loss, fatigue and I had nearly fainted twice that week. I was sent for a blood test and was told to come back next week. I was admitted to hospital that night with a confirmed diagnosis of Chronic Myeloid Leukaemia. I was 22. To say this was a very unexpected shock is an understatement!

Cases corner – 62 year old with dysuria and urinary frequency

Mrs G, is a 62 year old female, who presents to you with a two month history of urinary frequency and polydipsia. She has also noticed that her clothes feel looser. She is otherwise well in herself with no other symptoms. You perform a random plasma glucose which is 13 mmol/L. You also weigh her and she’s 7 kg lighter than last year (last recorded weight).

What would you do next?

  1. Confirm the diagnosis of diabetes and start treatment
  2. Refer the patient to endocrinologist
  3. Refer the patient along a 2-week-wait pathway
  4. Refer the patient for a CT scan of the pancreas

“Could this patient have cancer and how best should I investigate this possibility?”

C the Signs is a clinical decision support tool that makes my life as a GP so much easier. When faced with the clinical dilemma of “Could this patient have cancer and how best should I investigate this possibility?”, C the Signs offers me a tool that I can use during the consultation to check the best options available to me.

Born out of humour – Cancer on board

James was diagnosed with stage 3 cancer of the tonsil at the age of 44. The difficulties he experienced when accessing public transport for his appointments led him to start Cancer on Board.

“We joked with each other that we should pretend we were pregnant, so that people would offer us seats on the tube”

Cases corner – 65 years old with haematuria

Mrs B, a 65 year old woman, presents to you with a 2 week history of visible haemturia. She denies any other symptoms. Examination is unremarkable, but the blood tests you requested show an iron deficiency anaemia. A urine sample confirms visible haemturia and a culture is negative for infection.

Which cancer is Mrs B at risk of? (more than one may apply)

  1. Bladder
  2. Colorectal
  3. Endometrial
  4. Lung
  5. Renal

Shining a Light – The Brain Tumour Charity

Every day, 31 people in the UK are diagnosed with a brain, spinal or other intracranial tumour. The Brain Tumour Charity provides a variety of services online, over the phone and face-to-face to support as many people as possible.

News – C the Signs announces £1,000,000 award from SBRI Healthcare, an NHS England Initiative

We are delighted and honoured to be awarded £1m in funding from SBRI Healthcare. This funding will be transformative in how we diagnose patients with cancer, using our technology. Early diagnosis of cancer has the potential to save more lives than any cancer treatment in history. Using C the Signs technology, patients can be identified at the earliest and most curable stage of the disease. The future of cancer is survival.