Significant improvements in cancer survival in this country have been observed for most cancers over the past 10 to 20 years.
However, there is clear evidence that survival rates in England lag behind those in countries such as Australia, Canada and Sweden. Our one-year survival rates are particularly poor and there is broad agreement that late diagnosis is a major factor.
Late diagnosis is almost certainly due to a combination of late presentation by patients to their GP and late investigation and/or referral – and in some cases in primary care, poor access to diagnostics.
The National Cancer Awareness and Early Diagnosis Initiative (NAEDI) aims to tackle each of these problems and to promote research and evaluation in this area.
The initiative is jointly led by the Department of Health, Cancer Research UK and the National Cancer Action Team, with support from cancer networks, and working closely with the Royal College of General Practitioners.
Evidence indicates low public awareness of the signs and symptoms of cancer. In addition, many patients are worried about wasting their GP’s time if they do have symptoms.
To tackle this, the DH has developed public awareness programmes under the ‘Be Clear on Cancer’ brand. The campaign posters have pictures of GPs advising patients who do have these symptoms to see their GP.
These campaigns are first tested locally and regionally before being rolled out nationally.
Priority has been given to those cancers with the largest number of potentially avoidable deaths, which include breast cancer (particularly targeting older women who are not routinely invited for screening), bowel cancer and lung cancer.
Cancers with overlapping symptoms – such as blood in urine for kidney and bladder cancers – are being tackled jointly.
Impact on workload
Early results from the regional pilot campaigns for lung and bowel cancer have been positive and have been very well received by the public and GPs.
Awareness of the relevant symptoms – such as cough for lung cancer and blood in poo or loose poo for bowel cancer – has increased significantly.
Importantly, patients’ behaviour has changed, with more patients with the relevant symptoms attending their GP. The biggest increase has been in patients over 50, the target age for the campaigns. The increase in workload for GPs also appears to be manageable.
During the eight weeks of the pilot for the bowel cancer campaign, around one extra patient attended an average-sized practice per week, although the figures varied from practice to practice. For the lung cancer campaign, the equivalent figure was an average of 2.4 patients per week per practice.
The campaigns have not yet demonstrated a shift towards earlier diagnosis, but over time that is the clear goal.
Support for GPs
Alongside the public awareness campaigns, NAEDI is working with GPs to support them in assessing patients with symptoms possibly due to cancer.
The difficulties faced by GPs in making these assessments are well recognised. We are also aware that many GPs feel under pressure to limit referrals.
GPs have identified two main approaches as likely to be most helpful.
The first of these is the development of practice-based cancer profiles, showing a range of cancer-related parameters such as uptake of screening and usage of the urgent two-week wait referral pathway.
These are now available across the country and are being used by primary care cancer leads to stimulate reflection and discussion about local practice.
The second approach relates to the use of risk assessment tools. Approaches to risk assessment for cancer have been developed by Professor Willie Hamilton in Exeter and Professor Julia Hippisley-Cox in Nottingham. The risk assessment tool (RAT) developed by Willie Hamilton has been successfully piloted in over 150 general practices.
The large majority of GPs involved in the pilot reported that they found the RAT helpful. In many cases, the RAT confirmed their clinical judgment.
However, in other cases where the RAT estimate of the likelihood of cancer was higher than expected, GPs found this helped them to justify referral to hospital.
Our aim for 2012 is to assess both the acceptability and impact of these tools in routine general practice.
The NAEDI programme is still at an early stage of development and we need to learn what works and what does not.
However, doing nothing is not an option, as late diagnosis is currently resulting in thousands of avoidable deaths each year.
Professor Mike Richards is the national clinical director for cancer