NHS cancer guide for GPs and patients could save 5,000 lives a year, says Nice


Guidance on symptoms and tests drawn up by the National Institute for Health and Care Excellence for doctors and patients could transform cancer care in UK

Doctors are being advised to extend cancer tests to half a million more people a year under new guidelines which could eventually prevent 5,000 deaths a year.

Thousand of lives will be saved every year if GPs and patients act on new NHS guidance, which details for the first time the symptoms that could indicate cancer.

There are 10,000 more deaths from cancer in the UK every year than the average in Europe as a result of diagnosis that may come too late for effective treatment.

Half of those lives could be saved, the National Institute for Health and Care Excellence (Nice) said, if patients and their doctors used the guidance, which has taken three years to develop, on symptoms that could warn of one of 37 cancers. GPs will also be able to order more tests than at present, which should speed up a diagnosis.

“It’s about getting the right patients to the right tests at the right time,” said Willie Hamilton, professor of primary-care diagnostics at Exeter University, who helped develop the guidance. “One of the difficulties in our field is identifying the patient who has cancer over all the other patients who don’t.”

GPs are already able to request X-rays, blood tests and some scans, but now they will be able to get fast-tracked endoscopy investigations and MRI or CT brain scans tests that a specialist might order after referral of a patient but which will now bring a faster result.

There are 300,000 cancer diagnoses each year in the UK and 40,000 doctors, which means the average GP will see about eight. Under the new guidance, doctors and patients who suspect cancer will be able to look up the symptoms and find out which tests are appropriate.

Fatigue, for instance, might mean ovarian or lung cancer, mesothelioma or leukaemia, but unexplained fatigue in somebody over 40 who has ever smoked merits a chest X-ray for lung cancer. Unexplained fatigue in women would justify a blood test for ovarian cancer.

Abdominal pain could be a sign of one of five cancers. In the upper abdomen, with weight loss in the over-55s, it could be caused by oesophageal or stomach cancer, but occurring elsewhere in the abdomen, in a patient aged 60, an urgent CT scan might reveal pancreatic cancer.

Not every patient going to a GP will be assessed for cancer symptoms, but “there is an educational element to his guidance”, said Hamilton. “For some patients with abdominal pain, cancer is not the first thing you think of.” But, he added, “if your first idea of what you think is wrong with the patient turns out to be wrong, cancer will be higher up the agenda.”

The guidance is also “to inform the public where risks are and where risks aren’t”, said Dr Steve Hajioff, a director of public health and chair of the Nice guidance group. Some information patients can find online is useful and some is harmful, he said. “My personal view is that it is never wrong to share with people the information that allows them to make decisions about their own health.”

While more people may ask GPs whether they have cancer, others may read the guidance and decide they are not at risk. “Even if it were to increase, I would suggest that it is an appropriate increase,” said Hajioff. The savings from treating people early – in terms of lives as well as financial costs – would justify any increase in GP appointments and tests.

Hajioff told Radio 4’s Today programme on Tuesday: “We know there about 10,000 people a year who are dying of cancer in the UK over and above the European average. And about half of those, 5,000 people a year, because of delayed diagnosis. So we have broadened the criteria for who should be tested, to eliminate as much as we can of those 5,000 people who shouldn’t be dying every year.”

Dr Rosie Loftus, joint chief medical officer at Macmillan Cancer Support, said: “We know that every GP wants to do a good job and identify cancer early, and what will really enable them to do so consistently is more practical support in the workplace. In particular, they need more support to identify the symptoms of cancer types which are very hard to spot.”

Sara Hiom, director of early diagnosis for Cancer Research UK, said more diagnostic resources must be made available. “We know a lot more about symptoms and symptom clusters. For those patients who in the past have perhaps been let down by the system, we must remember a number of things, such as a diagnosis of cancer is a complex thing and cancer, while a common disease, is very rare in primary care.

“It certainly seems to be the case, and research would indicate, we do fewer diagnostic tests in this country than comparable countries, but there is a lack of workforce, perhaps a lack of kit, to do those tests, so patients may be missing out because there are delays, backlogs or bottlenecks and this really does need to be addressed.”

• This article was amended on 23 June 2015 to clarify that an x-ray is recommended for someone over 40 with unexplained fatigue who has ever smoked, not never smoked as a previous version said.

Powered by Guardian.co.ukThis article was written by Sarah Boseley Health editor, for The Guardian on Tuesday 23rd June 2015 00.29 Europe/London

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