More urgent referrals linked to lower cancer mortality

GP PRACTICES with a low propensity to use urgent two-week referral pathways for patients with suspected cancer had higher mortality rates for the disease according to a study published in the BMJ.

A research team lead by Professor Henrik Møller of King’s College London looked at the clinical records of 215 284 patients with cancer who were diagnosed or first treated in England in 2009 and then followed up to 2013. In that period 91 620 deaths occurred – 51, 606 (56 per cent) within the first year after diagnosis.

Among key findings, a subgroup of 37 per cent of cancer patients registered with general practices with a low propensity to use urgent referral was identified, and these patients showed a 7 per cent increased mortality rate compared with those from practices with higher rates of urgent referral. The association between use of the urgent referral pathway and mortality was consistent for the main types of cancer apart from breast cancer.

The researchers concluded that: "For practices that have a consistently low propensity to use the urgent referral pathway (for example, on measures and in consecutive years), the data suggest that an increased use could plausibly lead to lower mortality and higher survival of patients with cancer."

Responding to the findings, Dr Richard Roope, Cancer Lead for the Royal College of GPs and Cancer Research UK, said: "Across the UK, GPs are already doing a good job of appropriately referring our patients that we suspect of having cancer – 75 per cent of patients found to have cancer are referred after only one or two GP consultations.

"This research paper reinforces what we already know – early diagnosis of cancer results in better outcomes. During the study period those practices that referred a higher proportion of patients with symptoms indicating cancer using the urgent referral route had higher detection rates. Overall for England, the detection rate has increased from 42.9 per cent in 2010 to 48.8 per cent in 2014.

"The recent publication of the NICE Guidance for Suspected Cancer, and the Cancer Task Force, gives GPs the opportunity to lower the threshold for referring those with symptoms that could be caused by cancer, which will have the benefit of diagnosing more cancers at an earlier stage, with its associated better outcomes. It could also result in reduced numbers of consultations to reach a diagnosis, which would be universally welcomed in the face of the pressures currently facing primary care.

"However this can only be achieved if general practice is better resourced and GPs are given greater access to diagnostic tools such as CT and MRI scans. Our access is one of the worst in Europe and better access would mean we are able to refer even more appropriately, avoiding unnecessary distress for our patients and alleviating pressures on secondary care."