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One in four cancer patients experience delayed diagnoses

Some 49% of delays occur during GP assessment

Jo Carlowe

Wednesday, 04 December 2019

One in four cancer patients experienced a delay to their diagnosis that could have been avoided, according to a new study* by Cancer Research UK.

The study, published in Cancer Epidemiology, looked at data in the national cancer registry of around 14,300 people diagnosed with cancer in England in one year.


It found that nearly 3,400 patients experienced a delay that could have been avoided. Half of these patients waited around two months longer to be diagnosed compared with those who didn’t have an avoidable delay.

The reasons for delays are complex but researchers on this study attempted to identify what could go wrong. The study authors asked GPs to identify when the delay happened - before the patient saw their GP, while they were still being assessed by the GP practice or after they had referred them.

The data showed 13% of all avoidable delays happened before the patient saw their GP and 38% after the GP referred them to hospital. The other half (49%) happened while the patient was being assessed by the GP surgery including waiting for tests to be done and results to be sent back.

But long waiting times for tests were responsible for a quarter of all avoidable delays across GP surgeries and hospitals. According to Cancer Research UK, this is an indication of staffing shortages among diagnostic staff in hospitals.

Other examples of avoidable delays include patients with vague symptoms that a GP might not immediately attribute to cancer. For instance, patients with myeloma were more likely to experience delays while being assessed by their GP than patients with breast cancer.

Patients with pre-existing conditions were also more likely to experience an avoidable delay.

Ruth Swann, lead author and Cancer Research UK’s senior cancer information analyst, said: “Understanding when patients are experiencing delays leading up to their cancer diagnosis is really important to ensure people aren’t waiting unnecessarily for a potential diagnosis. Our research shows there’s a good opportunity to significantly reduce delays by cutting the time it takes for patients to have tests done. We need more research to develop and evaluate new diagnostic tests for patients with vague symptoms and a better way to manage them.”

Over the last few years, GPs have been referring more patients with suspected cancer symptoms earlier, but hospitals do not always have the staff to meet the growing number of patients, with one in 10 diagnostic posts vacant in the UK.

More than 363,000 people are diagnosed with cancer each year in the UK. This will increase to over 500,000 by 2035 - one person every minute, says Cancer UK.

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “Trying to find cancer in people with a range of symptoms and other conditions is very complicated. And while NHS doctors and nurses are doing everything they can to see patients quickly, the NHS is experiencing a staffing crisis. There simply aren’t enough people in the NHS to read scans or report tests swiftly.

“Waiting for a possible cancer diagnosis is an extremely anxious time, so no one should have to wait longer than is absolutely necessary. The government will never achieve the diagnosis and survival ambitions they have set unless they urgently address NHS workforce issues. Without more of the right staff, including GPs, it will be impossible to diagnose and treat patients more swiftly and effectively.”

Responding to the study, Professor Martin Marshall, chair of the Royal College of GPs, said: "GPs are doing a good job of referring patients we suspect of having cancer in a timely way. Research shows that nearly 80% of all cancer cases are now referred after only one or two consultations – and this is happening despite the widely acknowledged workload crisis in general practice.

"GPs have to balance the risk of not referring a patient with that of over-referring, which can cause unnecessary concern for patients and risks overloading specialist services. It's a decision that is exacerbated as many symptoms of cancer are vague and often likely to be other, more common conditions. The College has been calling for many years for GPs to have better access to diagnostic tests in the community – and the appropriate training to use them - so that our decisions to refer can be better informed, and in turn ease pressures elsewhere in the health service.

"Steps should undoubtedly be taken to reduce avoidable delays in cancer diagnosis – and lessons should be learnt from this study, which very clearly shows that the main problem is not having enough people, right across the system, to do what needs to be done to ensure patients receive the care they need when they need it.”


*Swann et al. The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients. Cancer Epidemiology, 2019

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