Delays in referrals for suspected cancer are unlikely to be down to poor performance by GPs, argue a team of researchers today in the British Medical Journal. Instead, they say that such delays largely reflect limitations in scientific knowledge and in the organisation and delivery of healthcare.
Diagnosing cancer soon after the onset of symptoms can better the outcomes for patients. But in order to achieve progress we need to have a clear understanding of why delays may occur
In an opinion piece published Dec 10th, a team of researchers including Dr Georgios Lyratzopoulos from the Primary Care Unit, Dept. of Public Health at the University of Cambridge question government plans to rank general practices according to how promptly patients later found to have cancer were referred to specialist services for suspected cancer.
Most patients who have cancer diagnosed after the onset of symptoms are referred after one or two GP consultations (80%), but a substantial minority (20%) have three or more consultations before referral, explain Dr Georgios Lyratzopoulos at the University of Cambridge, and colleagues. This number is often considered by policy makers and cancer charities to reflect an avoidable delay.
While multiple GP consultations prolong diagnostic intervals and may affect clinical outcomes and care experience, they largely reflect the diagnostic difficulty (or ‘symptom signature’) of different cancers and the need for initial investigations, argue the authors. For example, cancers with fairly specific signs and symptoms (such as a palpable breast lump or a visible lesion) are easier to suspect and are less associated with multiple consultations than those with non-specific symptoms (such as back or abdominal pain).
“Diagnosing cancer soon after the onset of symptoms can better the outcomes for patients,” says Dr Lyratzopoulos. “But in order to achieve progress we need to have a clear understanding of why delays may occur. The reasons are multi-faceted and reviewing the evidence we find that professional performance is an unlikely cause of delays. So we believe that government plans to rank general practices by referral times are unlikely to be effective.”
In turn, the researchers believe that strategies that can help to improve the speed of diagnosis may include clinical decision support tools for doctors to use during the consultation, greater degree of communication between general practitioners and specialists, and easier access to specialist tests such as scans and endoscopies. But they stress that novel diagnostic tests will need to be developed for cancers that are more difficult to detect.
The authors highlight that in some patients, delays in diagnosis can also occur before patients present to doctors or after GPs have referred the patient. They also advocate better information for the public, the media, and policy makers about the origins of prolonged intervals between presentation and diagnosis of cancer.
The research was funded by the National Institute for Health Research and Cancer Research UK.