UK researchers have called for better training and support for GPs after they uncovered ‘large variation’ in the number of pre-referral consultations for certain cancers.
New data from 41,000 patients in the National Cancer Patient Experience Survey – published in the Lancet today – show significant delays in the diagnosis of multiple myeloma, pancreatic cancer, stomach cancer and lung cancer in primary care.
Patients with these four cancers were more likely to have had three or more pre-referral consultations with their GP, with odds ratios of 3.42, 2.35, 1.96 and 1.68 respectively.
In contrast other cancers were more promptly referred. Breast cancer, melanoma, testicular cancer and endometrial cancer more likely to be referred to hospital after one or two consultations, with odds ratios of 0.19, 0.34, 0.47 and 0.59 respectively.
Results from the survey were first published in 2010, and prompted the Department of Health to reveal plans for GPs to be given direct access to diagnostics including colonoscopy, flexible sigmoidoscopy, and MRI scans.
These new data show in more detail the areas where delays in diagnosis are more common, with the probability of more consultations before diagnosis for younger patients, ethnic minorities and women.
The UK researchers concluded that GPs should have a ‘heightened level of suspicion’ for certain symptoms, and that the Government should prioritise initiatives to improve the diagnosis of cancers associated with a greater number of pre-referral consultations.
They added: ‘Such initiatives and research should explore and assess physician-level educational interventions, further development of point-of-care decision aids, risk calculators and diagnostic tests.’
Study leader Professor Greg Rubin, professor of general practice at Durham University, said the study showed the problem in identifying rare diseases that present with common symptoms.
He said: ‘A good example from our study is bladder cancer in women, who will presumably be presenting with urinary symptoms that are misattributed to infection or bladder dysfunction. Here the challenge is to ensure the possibility of cancer is considered in a timely way.’
‘For older ethnic minority patients, the problem may relate to patient-doctor communication difficulties and the extra effort that is sometimes needed to ensure interpreters are available and that sufficient time is taken to explore the problem fully.’
A DH spokesperson said they were committed to bring survival rates in England up to the European average: ‘We have committed £450million to help diagnose cancer earlier, and achieve our goal of saving 5000 extra lives every year. This money will give GPs’ direct access to tests to allow quicker diagnosis.’
‘This extra investment will also fund awareness campaigns of signs and symptoms for GPs and the public, as well as the extra costs for secondary care as more people are referred for specialist treatment.’