Delays in Cancer ReferralsPublished on: 15 October 2021
Cancer is defined by the NHS as “a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs.” It is because of this uncontrollable growth and reproduction of cells that early detection and commencement of treatment for cancer have long been considered the most effective method of improving outcomes for patients. Screening services have therefore been developed to try to detect cancers at their earliest stages, eg, breast and prostate cancer, but unfortunately this is not available for all cancers. For many patients, the path to being diagnosed begins when they attend their GP with worrying symptoms, such as unplanned weight loss, tiredness or unexplained bleeding.
GPs follow clinical guidelines to determine whether to refer the patient for specialist secondary opinion. The National Institute for Health and Care Excellence (NICE) states that for urgent referrals, the wait to see secondary healthcare should be within two weeks of the GP seeing the patient, or 48 hours if very urgent. It is obvious why such guidance is in place - the earlier a cancer is diagnosed, the better the chances of successfully treating it.
In an ideal world, every patient who presented to their GP with potential cancer symptoms would immediately be referred within the recommended two week timeline, if not before. They would receive a rapid diagnosis and quickly begin receiving appropriate treatment.
Sadly, we do not live in an ideal world, but nevertheless it is worrying to read that patients attending their GPs with concerns about such symptoms are not being referred for urgent investigations quickly enough.
The Independent recently reported on research funded by Cancer Research UK, which found that six out of 10 patients in England were not being referred within the two-week recommended period. The impact of delays in diagnosis on prognosis was alarming - a four-week delay alone increased the risk of death by 10%. It was appreciated by the authors that GPs are in a difficult position, conscious of being too cautious and over-referring patients, which could cause oncological services to become overwhelmed. However, this caution should not prevent a necessary and mandatory referral.
GPs are also challenged by patients with vague or very complex symptoms not typical of cancer, or those with pre-existing illnesses, as well as delays caused as GPs await diagnostic test results.
Delays in diagnosis of cancer cannot all be blamed upon GPs or any other healthcare provider. However, the NHS in England is reported to have failed to meet its target of diagnosing and treating 85% of cancer patients within two months, and has not met this target since 2015. Underfunding and difficulties recruiting and retaining trained staff across the NHS are compounding the issue.
This will undoubtedly worsen significantly as a consequence of the COVID-19 pandemic, during which patients have been reluctant or unable to attend their GP surgeries, with telephone and remote appointments becoming the norm. Although remote appointments may be more convenient for GPs to see patients, there is still the need to take a full and proper history to assess if a referral is required and ensure proper safety netting advice is given.
The results of the research need careful consideration to ensure that systems are in place going forwards to support both patients and GPs, and to ensure that those that need specialist services are referred as swiftly as possible.
Tune in to our podcast episode here in which we discuss delays in diagnosis of cancer.