How long does it take patients with symptoms of cancer to present to their GP?

Today we welcome guest blogger Stuart Keeble, who completed his MPhil in Public Health in our Department in 2013, to relate the story behind his recent paper with CCHSR and colleagues at the University of Durham, Bangor University and PHE’s National Cancer Intelligence Network.

A key action from the 2007 Cancer Reform strategy was to ensure cancer was diagnosed earlier in the UK. This led to concerted efforts to improve the awareness of cancer symptoms among the UK population with the aim of encouraging people to visit their GP sooner rather than later.

One of the main tools for increasing awareness and early awareness in the UK has been the national “Be clear on cancer” campaign. The “Be clear on cancer” brand has been used to raise awareness of cardinal cancer symptoms for tumour sites including bowel, lung, kidney and bladder, oesophago-gastric, ovarian cancers and breast cancer for women over 70 years.

Our ability to effectively prioritise future awareness raising efforts relies on understanding how long patients take to present to their health care practitioners for different cancers following the onset of potential symptoms (commonly referred to as the ‘patient interval’). Historically, little has been known about variation in patient interval between cancers making any form of evidence based prioritisation difficult. Secondary analysis of data from the National Audit of Cancer Diagnosis in Primary Care (NACDPC) provided us with the opportunity to examine variation in patient interval by cancer site.

We found large variation in the speed by which patients subsequently diagnosed with any one of 18 different cancers seek medical help once they notice their initial symptoms. On average, bladder and renal cancer patients had the shortest recorded patient intervals (2-3 days). In contrast, oesophageal and oropharyngeal (mouth) cancer patients on average had the longest recorded patient intervals (about 3 and 4 weeks respectively). Differences were also found by age, with younger patients experiencing longer patient intervals compared to older patients.

As our paper was published a new campaign to raise awareness about the symptoms of oral cancer was launched in Scotland. And a regional campaign on the symptoms of oesophago-gastric cancer (which include difficulty in swallowing) was launched in the North of England. It is hoped our findings will help in the future prioritisation of sustained awareness raising campaigns about the symptoms of these two cancers, nationwide.

You can also read how the paper was covered by lay media (such as the Mirror) and professional medial (such as the BMJ). We were also pleased to see it covered by the Cancer Research UK website (and also motivating a relevant science blog). You can read the actual paper (open access) here.

Stuart Keeble, Speciality Registrar in Public Health

Stuart Keeble, Gary A. Abel, Catherine L. Saunders, Sean McPhail, Fiona M. Walter, Richard D. Neal, Gregory P. Rubin and Georgios Lyratzopoulos

Variation in promptness of presentation among 10,297 patients subsequently diagnosed with one of 18 cancers: Evidence from a national audit of cancer diagnosis in primary care

International Journal of Cancer (2014) ‘Accepted Article’, doi: 10.1002/ijc.28763

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.