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GPs praised over speed of cancer diagnosis, but late presentations still a major problem

GPs are referring most cases of cancer promptly for treatment, but too many cases are only picked up when the patient presents as an emergency finds the results of a major RCGP audit.

The full results of the National Audit of Cancer Diagnosis in Primary Carefirst revealed by Pulse last year – were published today and show that three-quarters of patients with symptoms of cancer were investigated and referred to a specialist within a month of first seeing their GP in 2009/10.

However, the audit also points to several major factors that result in delays in cancer diagnosis, including cancers only being identified when patients present as an emergency and a lack of GP access to diagnostics such as MRI, endoscopy and ultrasound.

The report, the first of its kind, was carried out by the RCGP's Clinical Innovation and Research Centre in 2009/10 in response to the 2007 Cancer Reform Strategy that shifted awareness to early diagnosis. It analysed data on 18,879 patients with cancer, and from 1170 GP practices in England.

The comprehensive audit also found that almost three quarters of those patients who consulted a GP were referred within only one or two consultations, with nearly 60% of patients referred attending secondary care within two weeks.

Experts hailed the findings as evidence that GPs were doing a ‘very impressive' job in diagnosing cancer, and suggested that a major contributor to the UK's lower survival rates for some cancers was first diagnosis being delayed until patients present to hospital as emergencies.

Housebound patients, those with communication difficulties and those who present as emergencies tended to have more advanced cancer diagnosis, the audit found.

However, it found GP access to investigations varied widely by PCT and that direct access to cancer diagnostics would alter the management of patients with cancer by GPs in 6% of cases. Patients with brain, ovary, pancreas, liver and kidney cancer in particular would have benefited from better GP access to diagnostics.

Professor Greg Rubin, professor of general practice and primary care at Durham University and RCGP project lead for the audit, said of the results: ‘The good news is that many patients are identified promptly as needing specialist treatment, but we could do better and improved access to cancer tests would help in this.'

Professor Rubin also highlighted the need to better inform patients ‘to encourage people to come to their GP earlier', to educate GPs more on ‘non-specific symptoms' of cancer, and for researchers to look at why some groups ‘do less well than the rest of the population'.

Professor Sir Mike Richards, the Government's national clinical director for cancer and end of life care, said the report would help the Government ‘refine what we do to overcome the problem of late diagnosis.'

‘One of the key areas we are getting interested in is the patients who come as emergencies having never seen a GP,' he said. ‘This puts the focus back on emergency presentation.'

RCGP chair Dr Clare Gerada said the report showed that the majority of GPs were doing ‘fantastic work' in identifying patients with cancer.

Dr Gerada said: ‘While there are groups of patients where we do, for various reasons, have difficulty in making a rapid diagnosis we must be proud that the majority are being identified and put into secondary care quickly. At the same time, we must always be looking at how we can improve.'
 

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