National Institute of Health and Care Excellence (NICE) has issued updated guidance which it claims will enable GPs to use the symptom–based approach to help them diagnose cancer earlier potentially saving thousands of lives annually.
The updated and redesigned guideline will support GPs to recognise the signs and symptoms of 37 different cancers and refer people for the right tests faster. NICE says the new guideline will make it easier for GPs to think about the possibility of cancer sooner and refer people for tests quicker. This in turn will mean more people receive an early diagnosis and subsequently, more cancers could be cured.
The updated guideline uses a new approach – focusing on the symptoms that a patient might experience and go to their doctor with – to make its recommendations easier for GPs to use. It sets out clear tables linking signs and symptoms to possible cancers and includes simple recommendations about which tests to perform and the type of referral to specialist services that should be made.
According to NICE, nearly 50 per cent of people in the UK will be diagnosed with cancer in their lifetime. More than 300,000 new cancers are diagnosed annually in the UK, across over 200 different cancer types. Further, the disease is responsible for more than a quarter of all deaths in the UK; for many terminal cancer cases this will be due to a late diagnosis. However, NICE says that as many as 5,000 lives can be saved annually by making an earlier diagnosis of cancer.
The best way of tackling the disease is for patients to receive an early diagnosis, as this improves the chances of beating cancer. If cancer is caught at an early stage before the disease has spread treatment is more likely to be successful.
A full time GP will have between 6,000-8,000 appointments every year. And they will only have around 10 minutes per appointment to pick out warning signs that could be cancer, but equally may be a symptom of a less serious condition.
Often patients present at primary care with symptoms that are non-specific. Signs of cancer may also not be clear or obvious and GPs see, on average, only around eight new cases a year.
“The best way to successfully treat cancer is to make an early diagnosis. The sooner the disease is identified, the more likely treatment is to be effective. Earlier diagnoses have the potential to save thousands of lives each year”, says Professor Mark Baker, clinical practice director at NICE. “This guideline uniquely amongst guidelines of this type presents the evidence on the way that patients present to their GPs. It reflects real life and we expect it to have a major impact on the success rate for cancer in England.”
Recommendations in the update are now organised by symptoms which should prompt a 2 week wait referral; further investigation in primary care; and safety-netting in primary care. They cover:
- Abdominal symptoms
- Bleeding
- Gynaecological symptoms
- Lumps or masses
- Neurological symptoms
- Pain
- Respiratory symptoms
- Skeletal symptoms
- Skin or surface symptoms
- Urological symptoms
- Non-specific features of cancer
- Primary care investigations
The guideline also outlines which tests should be performed according to the type of cancer suspected, and if they can be done in a GP surgery or hospital clinic, as well as the timeframe for which referral patients should be referred to a specialist. This ranges from 48 hours to 2 weeks, depending on urgency.
