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GPs blamed unfairly for delays in cancer diagnosis

Delays are more likely to be due to non-specific presenting symptoms rather than poor GP care, an analysis suggests

Ingrid Torjesen

Wednesday, 10 December 2014

Poor GP performance is an unlikely cause of delays in referring patients for suspected cancer, researchers argue* in The BMJ. Delays are more likely to be due to “limitations in scientific knowledge and in the organisation and delivery of healthcare”, they say.

Most patients (80%) who receive a cancer diagnosis are referred after one or two GP consultations. However, a substantial minority (20%) have three or more consultations and policy makers and cancer charities often point to these figures as evidence of an avoidable delay. 

While multiple GP consultations prolong diagnostic intervals and may affect clinical outcomes and care experience, they largely reflect the diagnostic difficulty of different cancers and the need for initial investigations rather than poor care, argue Dr Georgios Lyratzopoulos at the University of Cambridge, and colleagues. For example, cancers with fairly specific signs and symptoms (such as a palpable breast lump or a visible lesion) are easier to suspect and are less associated with multiple consultations than those with non-specific symptoms (such as back or abdominal pain).

Delays in diagnosis also occur before patients present to a GP or after the GP has referred the patient, the authors point out. And policy initiatives focusing solely on professional performance, such as government plans to rank general practices according to how promptly patients are referred to specialist services for suspected cancer, are “unlikely to be effective”, they argue.

They believe that diagnosis “may be swifter if facilitated by decision support interventions, better interactions between generalists and specialists, and easier access to diagnostics.” But they stress that novel diagnostic tests will need to be developed for harder to suspect cancers and that future research and improvement strategies must recognise the role of variation in diagnostic difficulty across different cancers and organisational factors.


* Georgios Lyratzopoulos, et al. Rethinking diagnostic delay in cancer: how difficult is the diagnosis? BMJ 2014;349:g7400. doi:10.1136/bmj.g7400

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