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NHS Health Checks cancer awareness pilot picks up only four patients

A Government-backed pilot programme including questions about cancer symptoms in the NHS Health Check scheme has only picked up four patients with cancer.

The pilot – part of the Department of Health’s National Awareness and Early Diagnosis Initiative and run by NHS Tees - included the questions as part of an awareness campaign in 4,250 patients at high cardiovascular risk attending for health checks at GP surgeries.

The patients were sent a questionnaire of cancer symptoms and this was discussed with the practice nurse at the time of the health check. The nurse then examined the checklist and made specific enquiries about symptoms of possible cancer.

The researchers carrying out the pilot said the scheme was designed to raise awareness of cancer symptoms, but GPs said it could compromise the effectiveness of the other advice offered in the health check.

An evaluation of the scheme – presented by researchers at the Society for Academic Primary Care Conference in Glasgow this month – found 11% of patients were identified with a relevant cancer symptom and 6% were subsequently referred on to a GP.

Some 80% of the group referred to a GP required no further action and the remaining 20% were sent for further investigation, with the four cancer cases arising from this cohort.

Researchers concluded from focus groups that GPs accepted that case-finding was ‘congruent’ with their role and that that the intervention was accepted by patients.  NHS Tees is continuing funding for the scheme and hopes to widen its scope.

One of the study leads, Professor Greg Rubin, RCGP and Cancer Research UK clinical lead on cancer, the study showed that including symptom questionnaires was viable in NHS Health Checks.

He said: ‘This has shown that if you raise awareness that there is an increase in use of resources, but it is manageable. A GP’s role is not to necessarily be conducting the screening, but to take advantage of opportunities in a consultation to raise awareness.’

He added that the low numbers of patients detected with cancer was expected: ‘We didn’t expect to find many cases of cancer – in fact we found as many as we expected.

‘The aim was to improve awareness and subsequently encourage people to discuss potential symptoms of cancer with the practice nurse.’

But Dr Petula Chatterjee, a GP and cancer lead in Manchester, said the programme was likely to prove too costly to rollout.

She said: ‘There is no doubt educating the population around the symptoms of suspected cancers is an approach that a lot of cancer networks have adopted, but as this pilot shows, the returns on investigating large numbers of patients are small and costly.’

Dr John Ashcroft, a GP in Derbyshire and member of the Derbyshire CHD committee, said the scheme could have an adverse impact elsewhere.

He said: ‘There are many ways of spending vast sums of taxpayers’ money and not getting very much for it, and this appears to be one.’

‘It is probably compromising the effectiveness of the health check that is directed at our most common cause of death – cardiovascular disease.’

The results come after an evaluation of the Government’s flagship publicity campaign urging patients to see their GP earlier if they have symptoms of cancer found it was unlikely to have any significant impact on cancer referrals or diagnoses.

A Department of Health spokesperson said:’In an effort to improve cancer survival rates we are investing more than £750 million over the next four years to ensure people with cancer are diagnosed earlier and have better access to the latest treatments.

‘There are no plans to combine cancer screening with the NHS Health Check, which aims to prevent vascular diseases - heart disease, stroke, diabetes and kidney disease.These conditions often have similar risk factors.’

 

Diminishing returns

No. of symptomatic patients referred to GP – 245

No. that required no further action – 196

No. referred for further investigation – 49

Source: SAPC abstract number 1D.3

Readers' comments (1)

  • I can’t imagine why anyone would object to this sort of program. I would have thought it was the very essence of primary care, and am surprised that family doctors aren’t already doing it. Whether or not the results of this study lend further support to this type of practice is, however, unclear without further information. Some of the questions that immediately spring to mind are: Was there any proven increase in survival in those identified (including quality of life considerations) as a result of the screening over and above what would be expected in a similar cancer identified later? Was disease-specific mortality lowered? What happened to those whom the physicians decided not to investigate further? If indeed the proposed interventions and benefits to be derived from them are subject to the laws of diminishing returns then comments about this should be forthcoming, and the guidelines modified accordingly.

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