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Cancer patients from highest referring GP practices ‘have lower mortality rates’

Rising numbers of urgent two-week wait cancer referrals by GPs is reducing mortality rates in England, a study led by Public Health Engand and King’s College London has found.

The analysis of 1.4m cancer patients in England, published in the British Journal of General Practice, found patients from the highest referring GP practices had a lower mortality rate, with cancers diagnosed more quickly.

Researchers, which looked at data on breast, lung, prostate and colorectal cancers from the National Cancer Registry, concluded that an increase seen in the number of urgent two-week-wait referrals by GPs in England is helping to cut death rates from the disease.

They said this comes as urgent cancer referrals have risen to 2m per year in England, or an average 50-60 annual referrals per GP.

The study found that: ‘Cancer patients from the highest referring practices had a lower hazard of death (hazard ratio [HR] = 0.96; 95% confidence interval [CI] = 0.95 to 0.97), with similar patterns for individual cancers: colorectal (HR = 0.95; CI = 0.93 to 0.97); lung (HR = 0.95; CI = 0.94 to 0.97); breast (HR = 0.96; CI = 0.93 to 0.99); and prostate (HR = 0.88; CI = 0.85 to 0.91).

‘Similarly, for cancer patients from these practices, there were lower odds of late-stage diagnosis for individual cancer types, except for colorectal cancer.’

The paper concluded: ‘Higher practice use of referrals for suspected cancer is associated with lower mortality for the four most common types of cancer. A significant proportion of the observed mortality reduction is likely due to earlier stage at diagnosis, except for colorectal cancer.

‘This adds to evidence supporting the lowering of referral thresholds and consequent increased use of urgent referral for suspected cancer.’

Dr Thomas Round, from King’s College London and PHE said: ‘As a GP, considering a cancer diagnosis is not easy. A typical full time GP would have 8-9 new cancer cases per year but sees many patients who have symptoms which could be due to cancer.

‘The urgent referral, or two-week wait pathway, is very helpful for both patients, with potentially worrying symptoms, and their GPs who can fast track them to have a specialist review or tests.

‘This research shows that GPs are referring substantially more patients with suspected cancer, which is making a real impact in improving cancer outcomes in the NHS.’

He added that it was important for cancer referrals to continue during the Covid-19 pandemic.

He said: ‘With approximately 450 cancer deaths per day in the UK it’s important that we continue urgent referrals, diagnosis and treatment for cancer patients.’

This comes as NHS England has warned that some urgent cancer referrals will need to be downgraded during the pandemic.