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GPs quick to refer most suspected cancer cases

But cancers with less-specific symptoms can take much longer

Louise Prime

Friday, 08 February 2013

GPs take just two consultations to refer more than 80% of people suspected of having cancer, primary care research published in the British Journal of Cancer has shown – and more than half of cases are referred at the very first appointment.

UK researchers used data from the National Audit of Cancer Diagnosis in Primary Care 2009–10 to analyse the association between the interval from first symptomatic presentation to specialist referral, and the number of pre-referral consultations. The data covered 13,035 people with any of 18 different cancers.

Most (82%) of patients had been referred to a specialist after two consultations with the GP – and 58% were referred after the first GP consultation. Neither a patient’s age, sex nor ethnicity affected the number of consultations they had before being referred for suspected cancer.

But patients with some cancers, particularly those with poor symptom specificity, took longer to be referred. Almost half (46%) of people with multiple myeloma, and a third (33%) of those with lung cancer, had three or more pre-referral GP consultations – compared with just 3% of people with breast cancer and 5% of those with melanoma.

The researchers found a close association between the number of consultations before specialist referral, and the time from first presentation to specialist referral. They said: “Developing interventions to reduce the number of pre-referral consultations can help improve the timeliness of cancer diagnosis, and constitutes a priority for early diagnosis initiatives and research.

They said their results lend support to efforts to speed up cancer diagnosis – including GPs’ use of clinical decision support tools in their appraisal of cancer symptoms, as well as raising public awareness of the importance of persistent symptoms.

They concluded: “Improving the sensitivity of symptom appraisal by general practitioners to detect cancer symptoms should be prioritised by research and policy initiatives. Development and evaluation of interventions can particularly focus on patients with difficult-to-suspect cancers.”

Another study in the same journal examined the concern that it could seem insensitive to give lifestyle advice to cancer patients.

The researchers found that 88–93% of cancer patients’ close friends and family, and 87–93% of cancer survivors, agreed that it would be ‘beneficial’, ‘helpful’ and ‘encouraging’ for doctors to give advice on diet, activity and weight. Furthermore, 84–87% said that it was ‘the doctor’s duty’ to provide such advice. Only 10–18% of friends and family, and 10-24% of survivors, believed it was ‘unnecessary’, ‘interfering’, ‘insensitive’ or implied ‘blame’ to give lifestyle advice.

The authors concluded: “Few cancer survivors or members of social networks of individuals with cancer thought lifestyle advice would be insensitive, and most thought it would be beneficial. These results help counter doubts about the acceptability of lifestyle advice in the cancer context.”

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