Referral delays linked to lower UK cancer survival

LOWER cancer survival rates in the UK have been linked to delays in GPs referring patients for tests or to specialists, according research published in BMJ Open.

Results from the International Cancer Benchmarking Partnership (ICBP) – a collaboration between six countries from around the world with similar healthcare systems – show a link between survival and those countries where GPs were more likely to refer patients immediately. GPs in England, Wales and Northern Ireland were least likely to refer quickly and UK cancer survival was lower than each of the other countries examined except for Denmark.

Researchers analysed survey responses from 2,795 GPs on how they would manage patients coming to them with possible cases of either lung, colorectal or ovarian cancer. These were then mapped against survival data for those countries.

GPs were then asked a series of questions including what access they had to specific tests, waiting times for tests and results and whether they could speak to cancer specialists for advice.

More than 70 per cent of GPs in England, Wales and Northern Ireland reported direct access to blood tests, X-rays and ultrasound for possible cancer diagnosis – similar to the rest of the countries. But only around one in five GPs in England reported having direct access to CT and MRI scans while their peers in all other countries reported having at least twice the level of direct access to these tests.

GPs from across England, Wales and Northern Ireland also reported some of the longest waiting times for the results of CT, MRI and ultrasound scans.

Dr Peter Rose, lead author based at the University of Oxford, said: "These striking findings are the first to identify factors in primary care that could be contributing to international differences in cancer outcomes.

 "In particular they suggest that features of the interface between primary and specialist care in the UK may constrain the readiness of GPs to refer patients and may be important in our poor cancer survival compared with other countries. Further research is required to identify which specific factors could affect referral readiness for patients with cancer symptoms."

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: "GPs have a difficult job to do. They have to ensure those who need specialist tests get them, without overloading a health system that’s already strained. But their role as gatekeepers to further investigation and specialist care does need to be reviewed in the current context.

 "If the UK system means that patients are not being referred for tests or GP’s able to get a specialist opinion as necessary, then this can contribute to cancers being diagnosed and treated at a later stage and we urgently need to address this."