Six in 10 patients with ‘red flag’ cancer symptoms, including lumps and bleeding, are not being referred by GPs to specialists within the urgent two-week window.
This is according to research from the University of Exeter and the University College London (UCL) Institute of Epidemiology and Health, which also found that a significant number of patients who were not referred by their GP went on to develop cancer within a year of their consultation.
“GPs play a crucial role helping to diagnose cancer and many other important illnesses. The NHS deals with more than two million urgent referrals for suspected cancer each year,” said Professor Yoryos Lyratzopoulos from UCL.
“Our research shows that fully implementing urgent referral guidelines for symptoms of possible cancer would result in an even greater number of such referrals. We need to both resource the implementation of these guidelines, and develop and deploy new tests and risk assessment tools to help select patients at higher risk.”
Lead author Dr Bianca Wiering, of the University of Exeter, added: “We think this could be improved by stricter adherence to the [referral] guidelines and increased awareness of the groups of patients in whom symptoms are frequently missed, including younger patients.
“It’s important to note that this issue does not just lie with GPs – we also need to ensure the services to provide the tests needed on referral are well resourced, which we know is currently not always the case.”
The study, published in the BMJ Quality & Safety journal, analysed records relating to 49,000 patients who went to their GP in 2014 and 2015 with symptoms that could warrant referral under current clinical guidelines. They found that 29,045 were not referred for cancer investigation within two weeks of their first visit, 1,047 of whom developed cancer within a year.
The two week wait referral service (2WW) has been implemented as a means of fast-tracking patients with suspected cancer symptoms.
The red flag symptoms patients reported to their GP included blood in urine, a breast lump, problems swallowing, iron-deficiency anaemia, and postmenopausal or rectal bleeding.
The lowest 2WW referral rate was for problems swallowing, at just 17%, and the highest was for breast lump, at 68%.
Patients aged 18-24 were less likely to be referred than those aged 55-64, and people with more than one health condition were also less likely to be referred for further investigations.
Dr Jodie Moffat, head of early diagnosis at Cancer Research UK, said the findings were “worrying”.
“These data are from a little while ago so we don’t know what the situation is now, but with all the additional challenges of Covid-19, it’s vital that GPs and practice teams are supported to deliver the best care possible,” she said.
“This includes making sure GPs have easy and timely access to diagnostic tests needed to identify cancer. This requires resources and without long-term investment in staff and equipment we won’t meet government ambitions to diagnose cancer early.”