Six in ten patients with “red flag” cancer symptoms not referred for urgent investigation
Six in ten patients with common “alarm” symptoms for cancer are not referred for urgent investigation, a new large-scale study has found.
The research, led by the University of Exeter in collaboration with University College London and funded by Cancer Research UK, found that a significant number of patients who had not been referred developed cancer within a year following their consultation with the general practitioner.
One in two people is affected by cancer in their lifetime, and cancer is responsible for nearly 10 million deaths worldwide each year. Early diagnosis is known to be a major factor in saving lives.
Dr Gary Abel, University of Exeter, who led the research, said: “Over the past decade we have made tremendous strides in improving life-saving cancer diagnoses in the UK , in part thanks to general practitioners. Our study showed that patients who are referred are much more likely to be diagnosed with cancer within the next year than those who are not referred, so GPs are clearly referring patients most at risk to However, many patients did not receive an urgent referral within two weeks, unlike The number of patients who are diagnosed with cancer without an emergency referral indicates that more application strict guidelines would have significant benefits.
Our research found that a number of patients develop cancer after not being referred for warning symptoms. This could mean that an opportunity to diagnose cancer earlier has been missed. We believe this could be improved by tighter adherence to guidelines and increased awareness of patient groups in whom symptoms are frequently missed, including younger patients. It is important to note that this problem does not only concern general practitioners – we also need to ensure that the services to provide the tests necessary for referral are adequately resourced, which we know is currently not always the case “
Dr Bianca Wiering, Senior Author, University of Exeter
Posted today in BMJ Quality & Safety, the research team analyzed the records of nearly 49,000 patients who saw their GP with one of the warning signs of cancer that should warrant referral under clinical guidelines. They found that six in ten patients had not been referred for cancer investigation within two weeks of the first visit. Of the 29,045 unreferenced patients, 1,047 developed cancer within the year (3.6%).
The researchers processed records from the Clinical Practice Research Datalink, as well as statistics on hospital visits and cancer registration data between 2014 and 2015. They looked at patients who had first reported signs. cancer precursors to their GP. The “alarm” symptoms included blood in the urine, breast lump, swallowing problems, iron deficiency anemia, and postmenopausal or rectal bleeding.
The likelihood of a patient being referred within two weeks varied depending on the symptom they had. The lowest benchmark rate was for swallowing problems, at just 17 percent, and the highest was for breast mass, at 68 percent. However, the poorest patients were less likely to be referred for a breast mass.
Young patients, aged 18 to 24, were less likely to be referred than those aged 55 to 64, and people with more than one health problem were also less likely to be referred.
Dr Jodie Moffat, Head of Early Diagnosis at Cancer Research UK, said: “Determining who could have cancer among the hundreds or thousands of people a GP sees each year is an extremely difficult task. benefit from urgent referrals or tests for cancer, are intended to help diagnose cancer earlier. It is therefore worrying that people with warning symptoms are not referred.
“This data is only a short time ago, so we don’t know what the current situation is, but with all the additional challenges of COVID-19, it is essential that GPs and practice teams are supported to providing the best possible care. This includes ensuring that GPs have easy and quick access to the diagnostic tests needed to identify cancer. It requires resources and without long-term investment in staff and equipment, we will not be able to meet the government’s ambitions to diagnose cancer at an early stage. ”
Wiering, B., et al. (2021) Consistency with urgent referral guidelines in patients with any of the 6 “alarm” characteristics of possible cancer: a retrospective cohort study using linked primary care records. BMJ Quality & Safety. doi.org/10.1136/bmjqs-2021-013425.