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GPs play major part in halving time to diagnose child brain tumours

Exclusive The work of GPs has significantly helped cut the average time it takes for brain tumours to be diagnosed in children by more than half.

New figures, seen by Pulse, have revealed that the typical time to diagnosis has more than halved from over 14 weeks to 6.5 weeks.

Charity HeadSmart said GPs have played a major part in this, with the time from first presentation in primary care to diagnosis falling dramatically from over three weeks to just one week in recent years.

HeadSmart launched an awareness campaign – called ‘HeadSmart: Be Braing Tumour Aware’ – in 2011, designed to promote guidelines from the Royal College of Paediatric and Child Health published in 2008, partly to help improve doctors’ confidence in requesting CNS imaging at an early stage.

The RCGP has been working closely with the charity on the campaign to help disseminate the information to GPs, producing an e-learning module with researchers from the Children’s Brain Tumour Research Centre at the University of Nottingham.

The latest data from HeadSmart shows that:

  • the median time from onset of symptoms to diagnosis is around 6.5 weeks, compared with 14.4 weeks before the RCPH guidelines were launched;
  • the time from first medical contact –  frequently the patient’s GP – to diagnosis has fallen from 3.3 weeks to just one week since the awareness campaign launched.

The latest data is based on 334 patients at 15 Children’s Cancer and Leukaemia Group centres, covering over 75% of the incident cases of brain tumours between June 2014 and May 2015.

An earlier analysis in 2013 showed that the biggest reduction in total diagnostic time has come about through the fall in the time from presentation to diagnosis.

The figures come as HeadSmart is relaunching its campaign – including an update on most commonly presenting symptoms, notably increasing head circumference in under-fives and loss of vision in all age groups and the RCGP has made it the focus of a ‘clinical spotlight’ project.

Professor Helen Stokes-Lampard, chair of the RCGP, said: ‘It’s wonderful to hear that early identification of brain tumours in children is improving in primary care – especially as new presentation of this devastating disease is so rare in general practice.

‘But tragically, brain tumours are still the most common cause of cancer death in children, and there is absolutely no room for complacency.

‘The College has worked with HeadSmart and the Children’s Brain Tumour Research Centre at the University of Nottingham to develop a freely accessible toolkit, which includes access to detailed decision support tools, to support GPs and our teams in this particularly difficult area of our work.’

How GPs are improving early cancer diagnosis

GPs have been praised for helping to improve cancer survival over recent decades through their judicious use of the two-week wait urgent cancer referral pathway

A recent study concluded that greater use of this pathway is directly linked to better survival rates.

NHS chiefs and NICE signalled they want GPs to refer patients more readily for investigations, lowering the bar for referrals into the two-week wait pathway and introducing new immediate and 48-hour referral advice in a 2014 NICE guidance update

This formed part of a wider programme of work in which NHS England is also pushing a series of ‘early diagnosis’ projects around the country to try to help improve earlier diagnosis – including giving  GPs greater direct access to diagnostic tests and setting up one-stop shop multitesting centres for people presenting with vague but worrying symptoms.

However, there have been tensions over the use of cancer referral pathways with GPs reporting urgent referrals being ‘bounced’ or downgraded and some commissioning groups even offering ‘ethically questionable’ rewards to cut the amount of two-week wait referrals GPs make.