GPS missing cancer ‘red flags’ and not referring patients
PATIENTS with “red flag” cancer symptoms are being missed by GPS in more than half of cases, research has found.
The study of almost 50,000 patients who consulted their doctor before the pandemic with a symptom that could be a sign of cancer found six in 10 were not given an urgent referral.
Of those, almost four per cent went on to develop cancer within 12 months.
Pressure on GPS not to over-refer people for tests and a lack of awareness of cancer among younger patients were cited as possible reasons for the low referral rate. In England, an urgent referral means patients with possible cancer symptoms should be seen by a specialist within two weeks.
Red flags symptoms include, but are not limited to, blood in urine, a breast lump and problems swallowing, as defined by the National Institute for Health and Care Excellence (NICE).
The findings, published in the journal BMJ Quality & Safety, came as a separate report found almost 12,000 women could be living with undiagnosed breast cancer after missing out on NHS screening due to the pandemic.
Dr Bianca Wiering, a postdoctoral research associate at the University of Exeter who led the BMJ study, said that missed referrals could be improved by “stricter adherence to the guidelines and increased awareness of the groups of patients in whom symptoms are frequently missed, including younger patients”.
Dr Wiering told The Daily Telegraph: “There is some qualitative research showing that GPS feel under pressure to not refer because there may not be the resources at hospital to see all these patients.”
This latest study, led by the University of Exeter, working with University College London, and funded by Cancer Research UK, analysed records from 48,715 patients who presented with one of the warning signs for cancer.
Of the 29,045 patients not referred, 1,047 were diagnosed with cancer within a year (3.6 per cent).
The figures also showed 1,950 (10 per cent) of 19,670 referred patients tested positive for cancer which the researchers said showed that GP referral decisions are “not without value”.
But they added “given the number of patients diagnosed with cancer after non-referral, we may question whether clinical judgment is good enough”. Prof Martin Marshall, chairman of the Royal College of GPS, said: “GPS find themselves in a position where they are criticised for referring both too much and too little.
“What would help is better access to diagnostic tools in the community and additional training to use them and interpret the results, so that better informed referrals can be made.”
The researchers processed records from the Clinical Practice Research Datalink, as well as statistics on visits to hospital and cancer registration data between 2014 and 2015.
A patient’s age and symptoms also had an impact on their chances of referral. Younger patients (18–24 years) had 80 per cent lower odds of being referred compared to 55–64 year olds.
“The only symptom we looked at where the guidelines recommend urgent referral for 18-24 year olds is difficulty swallowing. Only 4.2 per cent of those were given an urgent referral, compared to 20.1 per cent in 55-64 years olds,” Dr Wiering said.
Among patients aged 25-34 presenting with a breast lump 55.5 per cent were referred, about 20 percentage points lower than 55-64 year olds.
An NHS spokesman said urgent GP referrals for suspected cancer “have been rising at around 200,000 each year, reaching 2.4 million last year and at record levels again this year”.