Patients with ‘red flag’ cancer symptoms not referred for urgent investigation in 60% of cases

Victim begged to see family doctor for 18 months 

After Michael Farrow experienced discomfort in his stomach, he spent 18 months begging to see a doctor at his local surgery but was repeatedly told he had acid reflux.

It was only after he and his wife paid for a private consultation that he discovered he had cancer of the oesophagus. He died four months later, aged 76.

His widow, Brenda, said: ‘It’s a disgrace. You have to fight to try and see someone – and that was happening even before Covid.’

Mr Farrow first contacted his GP in February last year and tried to get a face-to-face appointment ‘eight or nine’ times. He was offered phone consultations and treated for acid reflux.

When he finally had an endoscopy on April 1 after seeing a private doctor he was told he had had cancer for almost a year.

‘If he’d been referred right away he’d have had a better chance of getting over it,’ said Mrs Farrow, 75, of Litherland, near Liverpool.

He was put on chemotherapy but died on August 20. 

Six in 10 patients with ‘red flag’ cancer symptoms in England are not referred to a specialist by their GP quickly enough, a report has found.

Nearly one in 25 of those who were not given an urgent referral in the crucial two-week window went on to develop cancer within a year.

The report by the University of Exeter and University College London said it raises questions about whether GPs’ ‘clinical judgement is good enough’. 

Experts fear the problem is being ‘exacerbated by the lack of face-to-face appointments’ during the pandemic, with many GPs switching to virtual consultations by telephone or Zoom. 

Early diagnosis of cancer is known to be a major factor in saving lives. ‘Red flag’ symptoms include difficulties swallowing, iron deficiency, lumps and bleeding. 

Clinical guidelines introduced in England in 2000 state GPs should refer patients with possible cancer to a specialist within 14 days for tests and scans.

The study looked at nearly 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral.

It comes as the NHS England waiting list for routine hospital treatment hit 5.6million in July, which has soared since the pandemic hit the UK last March.

Almost half a million people were checked for cancer in June and July, among the highest numbers on record, as the health service attempts to catch up on people who have been missed over the last 18 months.

But nearly 20,000 fewer people than normal with cancer have not yet been diagnosed due to the backlog, according to analysis by the Institute for Public Policy Research and the CF healthcare consultancy.

The study, published in BMJ Quality & Safety, examined how well GPs followed guidelines for cancer referrals and the proportion of patients who weren’t referred but subsequently diagnosed with cancer. 

After Michael Farrow experienced discomfort in his stomach, he spent 18 months begging to see a doctor at his local surgery but was repeatedly told he had acid reflux

His widow, Brenda, said: 'It's a disgrace. You have to fight to try and see someone – and that was happening even before Covid'

His widow, Brenda, said: ‘It’s a disgrace. You have to fight to try and see someone – and that was happening even before Covid’

Thousands ‘living with undiagnosed breast cancer’ as pandemic hits NHS screening 

Almost 12,000 women could be living with undiagnosed breast cancer after missing out on screening and not being referred for tests due to the pandemic, a charity has warned.

Breast Cancer Now estimates there has been a 50 per cent rise in the number of women in the UK who have not had vital breast screening since services restarted last summer.

Overall, the charity estimates that almost 1.5million fewer women had breast screening between March 2020 and May 2021 when compared with pre-pandemic levels.

Disruption to NHS services has been caused by a variety of factors, including screening being paused at the height of the pandemic and fewer women being referred to specialists with possible symptoms of the disease.

This combination means that almost 12,000 people could be living with breast cancer without knowing it.

Breast Cancer Now said that for NHS England to meet its March 2022 target of addressing the shortfall in people starting cancer treatment, an extra 10,000 people would need to have started treatment for breast cancer between May 2021 and March 2022.

However, it said it is unclear how an already overstretched NHS workforce will be able to meet this demand.

The warning comes as the Royal College of Radiologists joined Breast Cancer Now in saying breast imaging and treatment services were ‘massively under-resourced even before the pandemic hit’.

It said breast screening teams are now trying to fit two years’ worth of appointments into one year.

Baroness Delyth Morgan, chief executive of Breast Cancer Now, said: ‘Women with breast cancer are continuing to pay the price due to the impact of the pandemic and, in the worst cases, delayed diagnoses could mean that some women die of this devastating disease.

‘Quickly finding and treating those with undiagnosed breast cancer must be a priority, and governments across the UK must urgently ensure there is sufficient investment to do this – these women do not have time to wait.’ 

Researchers also examined whether certain groups of patients were more likely than others to be referred within the two-week window.

They used a database of anonymised patient records – including hospital referrals and treatment, cancer diagnoses and postcodes – which covered seven per cent of the UK population.

Patients were included if they visited their GP in 2014 and 2015 – the latest data available for cancer diagnoses – with any one of six ‘red flag’ symptoms.

The symptoms included blood in urine, a breast lump, problems swallowing, iron-deficiency, and postmenopausal or rectal bleeding. 

In total, 48,715 consultations took place where an urgent referral for suspected cancer should have been recommended.

But just 40 per cent of the patients (19,760) were urgently referred within two weeks of seeing their GP.

Of those who were referred, 10 per cent were diagnosed with cancer within the next year.

Meanwhile, 3.6 per cent of those who were not referred were told they had cancer in the following 12 months.

The likelihood of a patient being referred within two weeks varied, depending on which symptom they showed.

The lowest referral rate was for problems swallowing, at just 17 per cent, and the highest was for breast lump, at 68 per cent.

Researchers said there are ‘several possible explanations’ for why urgent referrals weren’t made or recorded, including if patients were admitted to A&E, had an out-of-hours consultation or had already been referred for another condition. 

They wrote: ‘Given the proportion of patients going on to be diagnosed with cancer was considerably higher in those receiving an urgent referral than those who did not, we can conclude that GP referral decision-making is not without value.

‘However, given the number of patients diagnosed with cancer after non-referral, we may question whether clinical judgement is good enough. 

‘In these patients it can be argued that guideline-discordant decision-making may have resulted in a missed opportunity to diagnose early.’

‘Stricter adherence to the guidelines and increased awareness of patient groups especially at risk of long diagnostic timelines may help improve early diagnosis and ultimately cancer survival rates.

‘Due to the potential impact of regional health services, interventions to reduce guideline discordant behaviour may have more impact if they do not just focus on GPs and individual practices, but also on local diagnostic service provision.’

The average age of patients with the ‘red flag’ symptoms was 60.

And the most common symptoms were a breast lump (33 per cent) and rectal bleeding (27 per cent).

Most patients had at least one underlying conditions (80 per cent).

And a higher proportion of patients were from deprived areas than expected – 26 per cent rather than a projected 20 per cent.  

And rates varied ‘substantially’ among different GPs and practices. 

Researchers found that young people aged 18 to 24 and those with a higher number of coexisting conditions were less likely to be urgently referred.

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