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DO YOU WORRY ABOUT CANCER?

17 Jan

NHS England has ordered an independent taskforce to develop a five-year action plan with the aim of improving cancer survival rates and services.
The taskforce includes cancer specialist doctors, clinicians, patient groups and charity leaders, who will collectively look at ways to improve cancer prevention, first contact with services, diagnosis, treatment and support for those living with and beyond cancer and end of life care.

Early diagnosis of cancer:

The problem UK has relatively poor track record when compared with other European countries. It is estimated there are probably an additional 5-10,000 deaths each year most of which can be attributed to diagnostic delay.

Later diagnosis due to mixture of

  • late presentation by patient (alack awareness)

  •  Late recognition by GP

  • Delays in secondary care

In the last 18 moths new research from the National CANCER Intelligence Network has published the startling findings that in England 25% of cancers are diagnosed as emergencies. The figure rises with age implying that older people with symptoms are less likely to be investigated or referred early. More easily diagnosed cancers such as breast, uterine or melanoma are less likely to present in A&E but more difficult ones such as brain or pancreas are more likely to present in A&E .

58% brain tumours

39% of lung cases

25% colorectal cases

present as emergencies. Older women, women and people from ethnic minorities were more likely to present late.

If if a patient presents to their GP with symptoms we have the facility to refer under a 2 week rule which the patient is informed of at the consultation and an immediate referral is made to secondary care and they are contracted to see the patient within 2 weeks. However, it has been found that under half of current cancers are diagnosed with the 2 week urgent referral system.

For many years we as GP’s have used a risk stratification tool to establish a patient’s risk of a cardiovascular event( heart attack or stroke) and high risk patients are seen and treated and given relevant health education and this has resulted in a significant fall in cardiovascular events. One tool which is started to be used for cancer is QCancer  based on the QResearch database and pioneered at Nottingham university

It is a single tool to look at multiple cancers.

It has asymptomatic based approach but also takes into account risk factors such as age, smoking, alcohol, family history and weight.

90% of patients with cancer present with symptoms

Symptoms that  can be significant 

Key symptoms in model (identified from studies including NICE guidelines 2005)

 coughing up blood  vomiting blood  blood in the urine(painless)

Rectal bleeding  Unexplained bruising  Constipation, cough for >l 3 weeks

Vaginal bleeding (women) after intercourse or after menopause

  Testicular lump (men)  Loss of appetite  Unintentional weight loss

 Indigestion +/- heart burn  Difficulty swallowing

 Abdominal pain or swelling  Breast lump, pain, skin  Night sweats

Neck lump  Urinary symptoms (men)

We have started to use this in the practice and some of you may be aware of being handed a questionnaire in reception if not please ask for one. We will then create a score in the format of Cates Plot and relative risk which is entered in the records.

An example of a result showing an individual’s risk of having a cancer and a further breakdown of the results demonstrates which is the most likely cancer at risk – in this example it is a colorectal cancer. 

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If the score suggests  you have a risk of cancer  you will be asked to make an appointment to discuss this to arrange appropriate referral and investigations.

 It will also be updated if new symptoms occur. 

Hopefully during the next 12 months this will be fully integrated into our computer system rather than relying on paper questionnaires so that alerts can be triggered during regular consultations.

The following 12 types of cancer will be considered :-

Cancer

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