Anthony O’Brien explains recent changes in the fight against cancer
Every GP in the UK will see on average 3 patients/day who present with symptoms that might be caused by a cancer. However each GP will actually only have one new case of cancer per month diagnosed from the approximately 2000 patients they are responsible for. This demonstrates the difficulty of diagnosing cancer at an early stage. Catching cancer early is worthwhile as it significantly increases the prognosis for the patient. It is just clinically very difficult to do.
The NHS has been running a rapid access cancer investigation service for nearly 20 years. Patients who present with symptoms that make the ultimate diagnosis of cancer more likely are ‘Fast Tracked’ into a Two Week Wait appointment system. They are investigated and diagnosed quickly and if cancer is the cause then treatment can start as soon as possible. The thresholds for utilizing this Fast Track system have recently been lowered. This will have three effects. The first two are interdependent – the number of patients who will have rapid appointments and investigations will increase whilst the percentage of these patients who have cancer will decrease. Hopefully the overall effect will be a larger number of cancers being detected earlier and the population will reap the benefits of this.
The third effect relates to the costs of placing more people through the system. There are two elements to this. The first is the predictable financial strain on the NHS of seeing and investigating more patients overall. However this has a very measurable benefit in the expected improvement in UK cancer outcome statistics (currently lagging behind other countries in Europe). The other cost is harder to measure. More patients will be sent down the Fast Track system with the knowledge that they might have cancer and this will understandably cause concerns and anxieties. Currently only 10% (1 in 10) of patients who are ‘fast tracked’ end up with a diagnosis of cancer. In the future with the lower thresholds for investigation this is likely to fall to 5% (1 in 20). So if you do come and see your GP and are given a rapid access appointment you can be reassured that the odds still remain heavily in your favour. However if you are the unlucky patient you can also be reassured that you are getting quick investigation and treatment.
Of course in this battle we continue to fight against cancer the above system only works for patients who come to see their GP with their concerning symptoms (such as unexplained weight loss, change in bowel habit, blood in the stools). Most of the current delay in cancer diagnosis is not due to the systems or the clinicians running them it is down to the patients not using both of these early enough. The bird at least needs to have a chance of seeing the worm…… no matter how early he arrives!
Anthony O’Brien GP Wyndham House Silverton