GPs are diagnosing cancers earlier
Author: Adrian O'Dowd
GPs appear to be diagnosing cancers earlier and helping to reduce the numbers of cancer patients receiving their diagnosis in accident and emergency (A&E) departments, thereby improving their chance of survival.
The conclusion was made in a new study* published today in the British Journal of General Practice.
It is estimated that around a fifth of patients with cancer are diagnosed as an emergency, which is associated with worse clinical and patient experience outcomes compared with other diagnostic routes due to later stage at diagnosis and disease-related complications.
Reductions in the proportion of patients with cancer who are diagnosed as emergencies have been reported, but there is uncertainty about the responsible mechanisms involving tumour, patient and healthcare system factors, and how to achieve further reductions.
A team of researchers from University College London (UCL) and Public Health England set out to examine any sociodemographic, cancer site, and temporal associations with type of presentation among patients with cancer diagnosed as emergencies.
In this large study, the researchers studied Routes to Diagnosis data on 554,621 patients with cancer in England who presented as emergencies between 2006 to 2015.
They found there was a decline in the annual rate of emergency presentations, with emergency referrals from GPs falling by about a half.
The authors suggested this was likely to reflect increasing use by GPs of the two week wait referral pathways, as well as reductions in emergency presentations following a GP referral, likely indicating a trend towards earlier diagnosis in general practice.
Certain cancers associated with symptoms that may be tolerable to the patient but appropriately alarming to the GP (such as pancreatic cancer presenting with painless jaundice, or leukaemia found on blood testing) were more likely to be diagnosed after an emergency GP referral, possibly representing appropriate management.
In addition, patients presenting as emergencies were more likely to have been GP referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder, ovarian cancer, or acute leukaemia.
This is an observational study, and as such, cannot establish cause.
Nevertheless, Professor Georgios Lyratzopoulos who works as professor of cancer epidemiology at University College London, said: “More than a decade of monitoring of trends in care pathways before the diagnosis of cancer reveals that the NHS is continually getting better in diagnosing cancer earlier and avoiding emergency presentations, and GPs have played a crucial role in these improvements.
“But we also need new tests to help assess patients with non-specific symptoms. Novel diagnostic technologies are still much needed today as they were a decade ago.”
*Herbert A, Abel GA, Winters S, et al. Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015. Br J Gen Pract 2019. DOI:10.3399/bjgp19X705473.