Monday 3rd December 2012
The initial symptoms of some cancers can be difficult to distinguish from the symptoms of other more common disorders,1 and delays can occur between the first presentation and referral for a suspected cancer.
Late diagnosis is the single biggest cause of the relatively poor survival rates from cancer in England. This is particularly evident for breast and bowel cancer. Older people and those from deprived areas are also more likely to be diagnosed with cancer at a more advanced stage.
The Cancer Reform Strategy2 promotes further work with primary care professionals to ensure patients who present with possible cancer symptoms, have the appropriate investigations or are referred rapidly to a specialist for investigation. Early referral has a role to play in improving care for people with cancer, and in some cases, may improve survival rates.
To help with this issue, the Early Presentation of Cancer Programme (EPOC) is training GPs to use a rapid referral guidance tool developed by Macmillan. EPOC was set up in 2009 to lower cancer mortality rates in Lincolnshire’s growing and ageing population.
The tool will help GPs make decisions about when to refer people to specialists when they present with symptoms that could be caused by cancer. The tool is not about treating cancer, but sits on the GP's desk and contains a summary of the guidelines from the National Institute for Health and Clinical Excellence,3 referral times from primary care to specialist investigation for people with suspected cancer, and information about symptoms and risk factors. The tool covers:
- lung cancer
- upper gastrointestinal cancers
- lower gastrointestinal cancers
- breast cancer
- gynaecological cancers
- urological cancer
- haematological cancer
- skin cancers
- head and neck cancer, including thyroid
- brain and central nervous system cancer
- bone cancer and sarcoma.
Training to enable GPs to use the tool was delivered at the Marisco Medical Practice in Mablethorpe by Dr Irene Carter. Dr Carter says, ‘Having done an audit of our two-week wait referrals we were concerned about the wide variation within our practice. The guidelines help GPs decide when to follow the two-week referral system for seeing a specialist.’
The tool is currently being used by 10 GPs in Mablethorpe and Skegness, and after an evaluation of the pilot, we plan to offer the tool and training to every GP in the relevant Clinical Commissioning Groups by the end of 2012.
EPOC is funded by NHS Lincolnshire and Macmillan and delivered by the registered charity developmentplus.
Email Karen Parkinson, EPOC Development Worker (Sleaford Area).
1. Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. 1995. BMJ. 311: 486–8.
2. Cancer Rerform Strategy. 2007.
3. National Institute for Health and Clinical Excellence. CG27 Referral for suspected cancer. 2005.