The UK still lags behind other European countries in terms of its cancer survival rates. Efforts underway to speed up cancer diagnosis can help save more lives

One in two people will be diagnosed with cancer in their lifetime, and the disease is responsible for more than a quarter of all deaths in the UK. Research suggests that the UK and Ireland have lower survival rates than the European average for certain cancers.

Clearly, more needs to be done if the UK is going to match the best performing countries in terms of cancer survival rates. One major – although not the only – contributor to the UK’s cancer survival rates lagging behind other countries is “likely to be that patients are on average diagnosed later in the UK compared to the countries with better cancer survival estimates in Europe and elsewhere,” says Dr Mark Rutherford, a cancer epidemiologist at the University of Leicester. It is “absolutely critical” that the UK improves its rate of early diagnosis of cancer, he says.

“This will massively improve the likelihood of people surviving following a diagnosis.” The main obstacles to this happening are linked to the fact that it is not always easy to make an early diagnosis, Dr Rutherford explains. “Cancer is complicated, with many different signs and symptoms, some of which are common with other diseases,” he says.

“However, there are definitely areas where we can improve and are improving – by increasing public awareness of cancer signs and symptoms and also giving GPs the appropriate pathways and guidelines to make a swift cancer diagnosis where possible.” Indeed, to help speed up diagnosis rates, the National Institute for health and Care Excellence (NICE) has updated guidelines to support GPs in recognising signs of cancer and referring people for the right tests faster.

If GPs follow these guidelines, thousands of lives could be saved each year in England, NICE believes. The guidelines link signs and symptoms to possible cancers, provide simple recommendations about which tests to perform and the type of specialist referral necessary. They advise GPs to order certain tests themselves rather than referring to specialists first, to help speed up access to treatment.

“The new guidelines are good news for patients and GPs and there is no doubt that they will save lives,” says Matthew Wickenden, Cancer Research UK’s early diagnosis manager. “What they will help GPs to do is to get the right patients to the right tests at the right time. If a patient comes in and a GP has concerns about them, they will have more flexibility to refer them to a test or specialist and get that patient a diagnosis if they have cancer.”

Of all the people who are currently referred for urgent tests, only one in 10 has cancer. “This is a reassuring statistic for those people who are sent for tests, but it also reflects the fact that it is a real challenge to spot cancer symptoms. The new guidelines will definitely be an improvement in helping GPs to pick up on hard to spot cancers and some of the less obvious symptoms,” says Matthew.

Although the guidelines have been welcomed, there are concerns about whether they will have their intended positive effect. Chair of the Royal College of GPs, Dr Maureen Baker, commented that “at face value” the guidelines appear to be “very good news” for patients. But the concern is whether NICE has assessed the potential volume of patients and whether the system will cope with the increased number of referrals, or whether it might be swamped.

“If the onward services cannot cope with the work, we run the risk of patients actually having to wait longer for investigations and diagnosis, causing them further anxiety and stress,” said Dr Baker, adding: “It would be regrettable if something that was so well-intentioned resulted in patients being worse off.” The guidelines do have the potential to take the strain off the NHS.

Matthew highlights the possible positive outcome that if GPs are permitted to make speedier referrals, they won’t have to have repeat appointments with some patients, thus freeing up more of their time. He adds: “We also know that about one in four patients are diagnosed with cancer after presenting with signs which require emergency referral or presenting at A&E, which means they are being diagnosed at a later stage and therefore there is a greater cost to the NHS having to deal with that.”

“If we can reduce the number of people who are being diagnosed once symptoms have become that bad then these guidelines can help to reduce pressure on the NHS. We would hope that can happen.”

However, there are signs that the NHS is already having trouble coping with demand as it is. Matthew points out that in the last year, waiting time targets for diagnosis to treatment – known as the 62 day wait – in England and other parts of the UK have been missed. “That’s a sign that the NHS is struggling to keep up with demand,” he says.

“It’s likely that the guidelines will increase referrals for certain symptoms. We fully support the guidelines in their intentions. They’re based on the best evidence available to us on symptoms that could be cancer, but we need investment in the NHS to make sure services don’t get swamped. It’s now up to NHS commissioners to make sure these guidelines are a real benefit to patients rather than an opportunity missed.”

Know to go

Speedy diagnosis also relies on people going to see their GP as soon as they notice symptoms, and this is another issue that needs to be addressed further. Public campaigns can really help to improve the chances of diagnosing cancer earlier, Dr Rutherford believes.

“Knowing that a potential symptom could be a sign of cancer means that people are more likely to engage with the healthcare system if they experience it. However, it is also important to try to remove the fear of wasting GP time, particularly when it comes to persisting symptoms that may suggest a potential cancer case,” he explains.

When research, published in the British Journal of General Practice, looked into why people might not follow up possible cancer signs and see a GP quickly, the main obstacles in their path were: “Worries about wasting the doctor’s time; difficulty making an appointment; and lack of confidence that the GP could help. Other key barriers were people thinking symptoms were trivial or nothing to worry about and managing symptoms themselves,” says Dr Katriina Whitaker, a Cancer Research UK postdoctoral fellow who took part in the research.

GPs now have new guidelines to help diagnose cancer where possible

 

It’s also important that people should feel that seeking help is the right thing to do. “They shouldn’t be made to feel like a time waster if symptoms don't turn out to be cancer, which, in most cases, they won't,” adds Dr Whitaker. The ‘Be Clear on Cancer’ campaigns run by Public Health England, in partnership with the Department of Health and NHS England, aim to improve diagnosis rates by raising awareness of the signs of cancer and urging people not to delay seeing their GP.

So far, campaigns have been run for bowel, lung, breast, oesophago-gastric, bladder, kidney and ovarian cancers. But just how necessary are these campaigns? Dr Whitaker says that there is “increasing evidence” that campaigns raise awareness of symptoms and encourage people to seek help.

“We are starting to see evidence that this results in more investigations for cancer.” Awareness campaigns have boosted the number of people going to see their GP, according to a series of papers published in the British Journal of Cancer. For example, the ‘Be Clear on Cancer’ campaign led to an increase from 27 to 42 per cent of people who knew that blood in their poo could be a bowel cancer symptom.

“We have seen some great results from some of the campaigns,” adds Matthew. “For instance, the ‘Be Clear on Cancer’ lung cancer campaign led to 400 cancers being diagnosed at an early stage, with 300 of these people getting surgery. Lung cancer needs to be spotted early enough for surgery to be an option, which is why early diagnosis is a great benefit.”

The breast cancer campaign, which ran in early 2014, also had some really promising results. “Compared to early 2012, there was a 25 per cent increase in two week urgent referrals for potential breast cancer following the campaign,” says Matthew.

Loud and clear

For the most part, the target audience for the ‘Be Clear on Cancer’ campaigns are men and women in lower socioeconomic groups who are over the age of 50. As Matthew explains: “There are some shocking statistics that need to be addressed. One analysis found that in the UK, around 19,000 extra cancer deaths occur because of socioeconomic inequality.”

“This is linked to lifestyle, social barriers in the way of people seeing a GP and level of awareness of symptoms. When we are doing these campaigns we need to think about how to ensure we reach these groups with all important messages.” Pharmacies are well placed to spread the message that if anyone is experiencing persistent or unusual changes – for example, if someone asks for treatment for a cough that won’t go away – they should speak to their GP, he adds.

“Not every patient goes to see their GP when they first spot symptoms, so it’s still inevitable that even with the new NICE guidelines there will be some patients coming in at a late stage – either because their symptoms were hard to spot or because they dismissed their symptoms and didn’t act,” says Matthew. “We need to continue working with the public to make sure that they are confident to go to see their GP if they spot any unusual or persistent change in their body.”

A key message of the ‘Be Clear on Cancer’ campaigns – and one pharmacies can help to disseminate – is this: your GP will want to see you sooner, not later.