It has been 10 years (NICE CG27) since the cancer referral guidelines were updated. GPs will now be advised to refer a far greater number of patients for urgent cancer investigations, in particularly, lung, upper gastrointestinal and colorectal tumour groups and there is much emphasis on ‘straight-to-test’ and direct and rapid access to diagnostics.
The NICE guidelines NG12 Suspected cancer: recognition and referral has lowered the threshold for the positive predictive value of symptoms that should trigger a cancer assessment from 5 - 10% to ≤3%.
The new guidance follows a symptom approach and is based on primary care evidence looking at clusters of initial symptom(s). At present in England the two-week wait pathway detects just under 50% of all cancers. The hope is that by lowering the threshold and ensuring patients are tested rapidly not only will cancer detection rates increase, the stage at which cancers are diagnosed will also improve. At present 24% of cancers present as emergency – and often by then the prognosis is poor.
New criteria for an urgent cancer referral include the following:
- Aged over 40 with unexplained weight loss and abdominal pain
- Aged 55 and over with weight loss and upper abdominal pain, reflux or dyspepsia
- Aged 55 or over with upper abdominal pain and raised platelet count
- Aged 60 and over with weight loss and new-onset diabetes
- Aged 40 or over with chest signs compatible with lung cancer
- Aged 40–55, have never smoked, have haemoptysis and appetite loss
- Women aged under 55 with post-menopausal bleeding
- Aged over 50 and have unexplained rectal bleeding
- Children with unexplained bleeding
- Unexplained ulceration in the oral cavity lasting for more than 14 days
GPs are advised to follow the new guidance however it will take time for CCGs to commission services that follow NICE recommendations. In addition to clinical criteria changes, NG12 also highlight safety netting and safeguarding children and vulnerable adults.
A Rapid Referral guidance toolkit has been produced by Macmillan Cancer Support. It contains the guidelines with additional input from Macmillan GPs. It’s been produced by GPs for GPs with the aim of providing support, guidance and practical referral recommendations.
Evidence is emerging that locums may be ‘better’ at diagnosing cancer because they bring a fresh pair of eyes to a patient’s story and journey.
In keeping with Network Locum (now Lantum)’s dedication to its GPs and primary care community we would like to announce an interactive educational event to support GPs to understand the latest guidelines and implications.
Image: Suspect cancer (part 2- adults) BMJ 2015;350:h3044
In keeping with Network Locum (now Lantum)’s dedication to its GPs and primary care community we would like to announce an interactive educational event to support GPs to understand the latest guidelines and implications.
To book your place please visit our page on Eventbrite.
References:
- NICE NG12 Suspected cancer: recognition and referral
https://www.nice.org.uk/guidance/ng12 - Suspected cancer (part 2—adults): reference tables from updated NICE guidance BMJ 2015;350:h3044 http://www.bmj.com/content/350/bmj.h3044
Resources:
- Macmillan Rapid Referral Guidelines http://www.macmillan.org.uk/Documents/AboutUs/Health_professionals/PCCL/Rapidreferralguidelines.pdf
- Suspected cancer (part 1—children and young adults): visual overview of updated NICE guidance | The BMJ BMJ 2015;350:h3036 http://www.bmj.com/content/350/bmj.h3036
