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​New NICE guidance may delay cancer diagnoses, study finds

Current NICE guidance on two-week wait referrals for suspected cancer of the head and neck may cause delayed diagnoses, a study has found.

The updated suspected cancer guidelines (NG12), produced by NICE in June of last year, state that under certain criteria, GPs should refer patients for assessment by a dentist rather than directly to the two-week wait pathway.

Researchers at Leicester Royal Infirmary found that although this could reduce the burden on cancer diagnostic services, one in nine patients may have a cancer diagnosis delayed under the new guidance.

In a retrospective audit, they looked at how many patients who received a two week wait referral fit the NG12 criteria. It was found that 33 patients fit the NG12 guidance and nine of those were eligible to be referred for initial assessment by a dentist. One of the nine patients went on to be diagnosed with cancer.

The paper, published in the British Journal of Oral and Maxillofacial Surgery, said: 'If the population was reflected by our findings, one in nine patients would have their diagnoses delayed.'

But they acknowledged that larger studies will need to be conducted to see if this figure holds true.

The paper added that there is no guidance on appropriate referral in the event that a patient does not have a dentist, and that data suggested men, people who are older, or have lower socioeconomic status were most likely to be disadvantaged by this. It noted that this is 'the same groups at greatest risk of developing oral cancer'.

The study concluded: 'Our data combined with the epidemiological evidence, the lack of access to primary dental care, and a quality-assessed referral pathway between providers of primary care means the current guidance has the potential for more delays than the one it has replaced.'

The findings of the new study follow warnings earlier this year from surgeons at the British Association of Oral and Maxillofacial Surgeons (BAOMS) that this was the case.

At the time, NICE denied the claims, arguing that its guidelines were supported by the latest evidence. A spokesperson declined to comment on the new study.

Readers' comments (6)

  • So NHS dental Appts will be readily available for these examinations to take place??

    Or will we have to advise patients to go to a private dentist for this (£££)???

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  • Actually,I think ALL the updated NICE guidance will delay diagnoses on average. They want to lower the thresholds for 2ww referrals, which will hugely increase the numbers referred, and make far more breach the 2ww target.

    This will also mean that the non-2ww referrals have a longer delay as routine clinics are cancelled of more 2ww capacity, and the 30% or so of cancers referred in routinely will wait even longer.

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  • 2WW is also being used as a medic legal stick to beat GPs. I have spoken to several colleagues who have been successfully sued when a cancer was diagnosed after a routine referral. The fact that cancer was not obvious at the start is trumped by its eventual diagnosis, and the referring GP is lynched for not using 2WW.
    It may clog up OPD and further delay routine clinics, but when in doubt use 2WW or be prepared for the medico legal consequences.

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  • @ Anonymous | GP Partner13 Nov 2016 9:02am

    SPOT ON!

    When the sytem stops being so hostile and inflexible towards GPs then I might concider "abusing" the 2ww referral pathway. Unfortunatelt the establishment hates GPs and "loves" the so called patients/voters.

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  • Hang on - Sample size of 33? Seriously? this is a study? This is a randomised bullsh*t sieve.

    And aside from that, what was your analysis of delay? That a patient who might need a 2ww was seen by a dentist first and then referred? I don't suppose you looked at whether this changed outcome at all - oh, but there was only one, so it wouldn't be valid either way.

    Come on folks.

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  • 2ww was once of the biggest transfers of risk and work to GPs ever to take place under the radar of the GPC. In the old system, consultants were responsible for triage and prioritizing their referrals and hospitals were required to 'keep up'. The 2ww scam set an absurdly low-risk threshold of 3% based on a range of presentations that bear little resemblance to the complexities of real-life general practice.If anything goes wrong we get strung up by the retro-spectroscope. NICE cancer guidance is a scam and should be withdrawn. There should be an inquiry into how this was allowed and who's interests profited. http://blogs.bmj.com/bmj/2015/12/09/will-stahl-timmins-almost-impossible-cancer-spaghetti/

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