Case Study - Cancer 'Red Flags'

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redflags

The recent attention on Jeremy Hunt’s initiative to make public the GPs and practices who are underperforming with their cancer referrals has attracted much debate on the efficacy/inefficacy and advantages/disadvantages of the idea. Whichever side you stand with, as GPs what we can and should focus on is positively impacting the diagnosis statistics through the quality of care we provide.

One in three people are diagnosed with cancer in their lifetimes, and one in four people die from it while the ‘two-week wait referral’ pathway currently detects less than 50 per cent of cancers in England.  Cancer continues to lead as the primary cause of premature deaths in the under-75s and Britain is far behind its European counterparts in detection.

UK primary care researchers have identified a list of ‘red flag’ symptoms that have a positive predictive value (PPV) of 5% or more for different cancers and would ‘require action by a GP'. I feel GPs should not only be guided by the red flag symptoms, but also proactively audit practice records to identify patients with any of the symptoms and reflect upon these cases as part of their appraisal and revalidation to improve quality of care.

QCancer, a risk algorithm, is designed to assist GPs in the early detection of cancer, and should be integrated with EmisWeb later this year. This will allow practices to survey their entire patient population and stratify their cancer risk.

The key red flags are:

Anaemia – in men with Hb ≤ 12g/dl aged 20 and older and women with Hb ≤11 g/dl aged 50 and over
Blood in urine – in men and women aged 60 and over
Coughing up blood – in men over 55 and women over 65
Difficulty swallowing – men over 55
Breast lump or mass – in women aged 20 and older
Post-menopausal bleeding – in women aged 75-84
Abnormal rectal examination – in men 40 and older
Rectal bleeding – in men and women aged 75 and older

When faced with any of these symptoms it is imperative we ' think cancer' and ensure any safety netting, investigations or two-week wait referrals are performed in a timely manner, paying attention to emphasising the importance of follow up and surveillance in these patients.

Dr Ishani Patel
MBBS BSc MRCGP DCH DRCOG
General Practitioner
E-learning CPD Fellow, RCGP
Associate GP, Cancer Commissioning Team – North West & South London
Advisory Committee on Cervical Screening (ACCS), Public Health England

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References:

http://www.qcancer.org/

http://www.theguardian.com/society/2014/jul/08/jeremy-hunt-plan-shame-gps-lowjo mcka-cancer-referrals-not-the-answer

https://www.cancertoolkit.co.uk/

 

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