Lower cancer survival in UK linked to delays in referring patients for tests

Cancer Research UK

GPs in England, Wales and Northern Ireland are less likely to immediately refer people with possible cancer for tests or to a specialist than those in comparable countries, according to new research published in BMJ Open* today (Thursday).

"If the UK system means that patients are not being referred for tests or GP’s able to get a specialist opinion as necessary, then this can contribute to cancers being diagnosed and treated at a later stage and we urgently need to address this." - Sara Hiom, Cancer Research UK

The research shows a link between survival and those countries where GPs were more likely to refer patients immediately and those who did not. The UK based GPs were least likely to refer quickly.

UK cancer survival is lower than each of the other countries examined except for Denmark.

The results from the International Cancer Benchmarking Partnership (ICBP) - a collaboration between six countries from around the world with similar health care systems - reveals striking new evidence for a possible explanation of international survival differences.

Researchers analysed survey responses from 2795 GPs on how they would manage different scenarios of patients coming to them with possible cases of either lung, colorectal or ovarian cancer. These were then mapped against survival data for those countries. 

GPs were then asked a series of questions including what access they had to specific tests, waiting times for tests and results and whether they could speak to cancer specialists for advice.

More than 70 per cent of GPs in England, Wales and Northern Ireland reported direct access to blood tests, X-rays and ultrasound for possible cancer diagnosis – similar to the rest of the countries.

Australian GPs in Victoria reported the highest access - around 99 per cent - to all these tests. 

But only around one in five GPs in England reported having direct access to CT and MRI scans while their peers in all other countries reported having at least twice the level of direct access to these tests**.

GPs from across England, Wales and Northern Ireland also reported some of the longest waiting times for the results of CT, MRI and ultrasound scans.

Northern Ireland has the longest waiting times for tests and results of ultra sound and CT scans, around seven to eight weeks for each. England’s waiting time for the same tests was nearly five weeks and Wales was around seven weeks for both types of scan. The best performing region was New South Wales with a total waiting time of around one and a half weeks.

As well as delivering better results for patients, cancers detected at earlier stages generally cost considerably less to treat.

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “This work adds important detail to the complex problem of why the UK’s cancer survival lags behind other comparable countries. GPs have a difficult job to do. They have to ensure those who need specialist tests get them, without overloading a health system that’s already strained. But their role as gatekeepers to further investigation and specialist care does need to be reviewed in the current context. If the UK system means that patients are not being referred for tests or GP’s able to get a specialist opinion as necessary, then this can contribute to cancers being diagnosed and treated at a later stage and we urgently need to address this.

“A system that allows GPs to refer people when and if they suspect cancer is vital to ensure early diagnosis and access to the best treatments. Cancer Research UK is working with GPs to improve early diagnosis and with local and national decision makers to ensure people with cancer are diagnosed promptly and efficiently.”

Dr Peter Rose, lead author based at the University of Oxford, said: “These striking findings are the first to identify factors in primary care that could be contributing to international differences in cancer outcomes. In particular they suggest that features of the interface between primary and specialist care in the UK may constrain the readiness of GPs to refer patients and may be important in our poor cancer survival compared with other countries. Further research is required to identify which specific factors could affect referral readiness for patients with cancer symptoms.”

Dr Richard Roope, Royal College of GPs and Cancer Research UK’s clinical lead for cancer, said: “We must remember that the average GP sees hundreds if not thousands of patients a year with potential cancer symptoms – but only an average of eight will be diagnosed with cancer. Data suggests that more cancer cases are being diagnosed earlier, but there is still room for improvement. Cancer Research UK is helping GP practices by providing data, resources and training to help GPs refer the right patients at the right time and so ensure cancer patients are diagnosed as quickly as possible.”

ENDS

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References

* Rose, P. et al. Explaining variation in cancer survival between eleven jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey. BMJ Open. 2015.

Notes to Editor

The survey was completed in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (United Kingdom), Denmark, Norway, Sweden.

** The figures for NI and Wales vary

  • ENG CT= 21.5%; MRI=19.9%
  • NI CT= 27.5%; MRI = 11.0%
  • Wales CT= 46.3; MRI= 31.2%

Compared to 91.6% for MRI in Ontario and close to 100% for CT in Victoria and NSW

About the patient scenarios

There were five patient scenarios: two lung, two colorectal, one ovarian. The hypothetical patients present with a range of symptoms which may or may not indicate cancer – in fact, respondents receive feedback to show that not all patients were eventually diagnosed with cancer. At the first visit, the GP is presented with a range of options for immediate action including giving advice, to manage symptoms, a range of investigations, or referral to a specialist.

If the GP opted to investigate or refer the patient to a specialist the scenario came to an end. If not, the scenario continued with the patient returning to the GP with their symptoms having developed. Once again, if the GP opted to investigate or refer the patient the scenario came to an end. The overwhelming majority of scenarios were concluded at the end of the second visit, only a very small number of respondents went on to a third patient visit (after which the scenario would have ended, whatever the outcome).

About the International Cancer Benchmarking Partnership (ICBP):

The International Cancer Benchmarking Partnership (ICBP) is a unique and innovative global partnership of clinicians, academics and policymakers. The ICBP is funded by the partners representing each jurisdiction, in the UK this includes the Department of Health, The Northern Ireland Cancer Registry, the Public Health Agency, Northern Ireland, South Wales Cancer Network, Tenovus, and the Welsh Government. Cancer Research UK programme manage the partnership. www.icbp.org.uk