The content of this website is intended for healthcare professionals only

Work needed to boost GPs’ knowledge of cancer drug

Only a quarter of GPs aware of NICE guideline on tamoxifen

Adrian O'Dowd

Tuesday, 14 February 2017

Better coordination is needed between GPs and hospital specialists to improve the former’s knowledge of breast cancer drug tamoxifen, according to a study* published today in the British Journal of General Practice (BJGP).

The Cancer Research UK funded study found poor knowledge amongst GPs of the drug and its preventive benefits for women.

In the UK, more than 53,000 women are diagnosed with breast cancer each year, and 11,000 die of the disease. Women with a family history of the disease have a higher risk and this accounts for 5–10% of all breast cancer cases, so prevention is important.

The cancer strategy for England recommends that GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk and NICE has produced guidance which recommends tamoxifen to prevent breast cancer among women with a clear family history of the disease.

Researchers led by Dr Samuel Smith, a Cancer Research UK Fellow at the University of Leeds, carried out a survey which received responses from 928 GPs from across the UK (apart from Scotland because an agreed care pathway already exists there for the prescription of tamoxifen).

Results showed that only around half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and only a quarter (24.1%) were aware of the NICE guideline.

GPs were more comfortable in discussing, and more willing to prescribe or recommend tamoxifen if supported by secondary care clinicians.

Around two third (68.9%) of GPs responding in the survey who were asked to initiate prescribing (GP prescriber) were willing to prescribe tamoxifen but this was noticeably less than the 84.6% of those continuing a prescription initiated in secondary care.

Dr Smith said: “Our report helps us to understand GP attitudes towards the use of cancer preventing drugs.

“It’s clear that more needs to be done to promote the evidence and guidance associated with these drugs, particularly as research reveals GPs are lacking the support to discuss effectively the risks and benefits of preventive therapy.”

The authors concluded: “Initiating tamoxifen prescriptions for preventive therapy in secondary care before asking GPs to continue the patient’s care may overcome some prescribing barriers.”

A shared care agreement between primary and secondary care could alleviate a number of concerns, and facilitate appropriate prescribing, they added.

Professor Arnie Purushotham, Cancer Research UK’s senior clinical adviser, said: “Cancer-preventing drugs have the potential to have a huge impact by reducing the risk of cancer developing in the first place. It’s vital that GPs are given the right support and information so they are confident to explore the value of these drugs with those who would benefit from them, wherever they are in the UK.”

Responding to the research, Professor Helen Stokes-Lampard, chair of the RCGP, said: “The benefits of using long-term medication to lower the risk of developing cancer are becoming clearer as new research findings become available – and it’s important that this informs official clinical guidelines, and that GPs and our teams are aware of them.

“But with clinical guidelines rightly being updated so frequently and given the incredibly broad spectrum of knowledge GPs need to have, it’s understandable that family doctors often take cues from our specialist colleagues in hospitals – so improved communication channels between primary and secondary care would certainly be helpful.”

* Smith SG, et al. Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs’ attitudes. British Journal of General Practice, 2017. DOI: 10.3399/bjgp17X689377.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470