EVIDENCE FOR EARLY DIAGNOSIS
There is a coherent commitment to support early diagnosis in primary care as outlined in key policy documents such as the Five Year Forward View, the Independent Cancer Task Force Review – Achieving World-Class Cancer outcomes: a strategy for England 2015-2020 and the International Cancer Benchmarking Partnership.
The new NICE guidelines Suspected cancer: recognition and erenceerral (NG12) have gone further than ever before to diagnose more patients early. Using primary care data and evidence, the guideline recommends more signs and symptoms that feature in the early stages of Cancer. They lower the positive predictive value ‘threshold’ of when a symptom, or collections of symptoms should trigger a referral, from 5% to 3%. This means, that any patient with a 3/100 chance of having Cancer (or higher) should be referred. Some of the recommendations for children and young people have been set lower than this.
The lowered threshold at 3% will enable more patients to be diagnosed at the early stages of Cancer. In addition to this, there are more pathways for direct access diagnostics to supports GPs to refer patients directly for scans and endoscopies. Currently 25% of patients are diagnosed in Accident and Emergency, usually as a complication of their Cancer; as such they face poorer outcomes. The guidelines plan to drive more referrals and diagnostics using dedicated patient pathways in Primary care.
Cancer patients diagnosed in A&E
Primary care is well placed, as this is where the patient presents first. GPs however, are generalist not specialists, caring for patients with a whole breadth of conditions and illnesses. The early signs and symptoms of Cancer are vague, non-specific and overlap with other long-term health conditions. On average GPs will see fewer than eight new patients with cancer each year, and may see a rare cancer once in their career.
GPs are expected to memorise a multitude of guidelines and diagnostic criteria, which they are held accountable to. This is becoming increasingly difficult in the current climate of General Practice, with rising workload and workforce shortages. Within the constraints of a 10minute appointment, this can prove extremely challenging, especially when existing decision support tools are paper base, long and inaccessible.