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01
Dec
Saving lives through early diagnosis

written by

Leukaemia Care, Charity

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Recently, the importance of early diagnosis of cancer is a subject popular with healthcare professionals, patients, patient organisations and the media alike. A recent study, published in the British Medical Journal, reported that around 2,400 deaths could be prevented in the UK each year if patients were referred for cancer diagnostic tests sooner by their GP.

The need for improvement in diagnostics within the NHS has been observed by the government and is the focus of the Independent Cancer Taskforce, which was established to develop a five-year strategy for cancer services in the UK. It has recently published a report that recommends earlier diagnosis as a priority to help the NHS achieve “world-class cancer outcomes”. The strategy put forward by the Cancer Taskforce needs to become a reality for more cancer patients. An improvement to GP access to diagnostic tests, and diagnostic services more broadly, will help patients’ treatment to begin sooner and would be “transformative” by enhancing their quality of life and could potentially save lives.

According to Cancer Research UK, if the UK could catch up with the EU average and more patients were diagnosed earlier, up to 7,000 deaths could be avoided each year, with the lives of an estimated 1,000 blood cancer patients saved annually. It is clear then that an improvement in GP access to diagnostic services and a system that “promotes investigative testing” is drastically needed for the NHS to keep up with cancer survival rates in the rest of Europe.

Dr. Rosie Loftus, Chief Medical Officer at Macmillan Cancer Support, has suggested that “England’s cancer survival is amongst the worst in Europe [due to] inadequate access to cancer tests and treatment.” Blood cancer survival in the UK is also notably lower than comparable countries in Europe.  It is thought that this is partly due to patients not being referred for tests quickly enough by their GPs. The Cancer Taskforce report has suggested that this is because of the level of pressure that NHS diagnostic services are under due to workforce and funding shortages.

These shortcomings in our health service are leading to cancers being diagnosed in an emergency setting. At this stage, the cancer is more likely to be advanced, which unfortunately leads to less positive treatment outcomes and lower patient survival rates. This is a particular issue for blood cancers. Between 2006 and 2013, about 30% of all blood cancer patients were diagnosed via emergency presentation,  compared to the average for all cancers which is 22%. As an example, in this time, 64% of all patients with acute lymphoblastic leukaemia’s were diagnosed in this setting which is the highest percentage of any cancer.

More positively, other studies have found that GP’s are getting better at spotting possible cancer symptoms and are referring patients for diagnostic tests more rapidly as the proportion of cancers diagnosed as an emergency at hospital has decreased in recent years. That said, 33% of blood cancer patients are still being diagnosed via the emergency admissions route which shows that more resources and support are required for further improvement to continue.

A system that allows GP’s to refer patients when they suspect cancer straight away is essential to ensuring earlier diagnosis and access to better treatment. GP’s are key players in improving earlier diagnosis because of their level of communication with patients and the central role that they play in recognising symptoms.  However, the average GP will see fewer than eight new cases of cancer per year, most will be a more common form of cancer, and less than one a year will be a blood cancer. Symptoms of blood cancer, which include fatigue, night sweats, joint pain, bruising and recurrent infections, are vague and can be linked to other, less serious illnesses. Unfortunately, the non-specific symptoms of blood cancer make it trickier for GP’s to diagnose it quickly as there is no specific referral pathway - this means it can take longer for patients to be referred for tests. This demonstrates the need for support for GP’s when it comes to diagnosing rarer cancers and the Cancer Taskforce has suggested that an improvement in GP training in terms of managing uncertainty and risk in diagnosing patients is necessary to aid earlier diagnosis.

Whilst it is the government’s responsibility to ensure that GP’s have the support they need to diagnose patients more quickly by ensuring diagnostic services are available immediately, patient organisations can help too. Leukaemia CARE has been working with the Royal College of General Practitioners (RCGP) to create an e-learning tool to help GP’s recognise symptoms that may indicate a patient has blood cancer. Helping GP’s to be more aware of the non-specific nature of the symptoms of blood cancer could prompt them to refer patients for specialist tests more urgently if they do suspect a blood cancer, hopefully leading to an earlier diagnosis. Early diagnosis saves lives and is fundamental to improving patient treatment outcomes, contributing to an improvement in UK cancer survival and bringing it in line with the rest of Europe.