How many times will you see your GP before they think cancer and refer? It depends!

Lyratzopoulos G, Neal RD, Barbiere JM, Rubin GP, & Abel GA (2012). Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England. The lancet oncology, 13 (4), 353-65 PMID: 22365494 Access this article.

Back in February 2012 we published a paper with colleagues from the Universities of Durham and Bangor in the Lancet Oncology (Georgios Lyratzopoulos, Richard D Neal, Josephine M Barbiere, Gregory P Rubin, Gary A Abel, Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England., Lancet Oncol. 2012;13(4):353-65). Here is the story behind the paper.

GPs do many things in the UK, but one of their more important functions is to act as a gatekeeper to secondary care. Whilst this has many upsides, it has been blamed by some for at least part of the relatively poorer survival of cancer patients in the UK compared to other developed nations. Whether or not this blame is justified, a timely referral with a suspected cancer diagnosis is desirable with patients expressing a strong preference for avoiding the inconvenience and stress of reconsulting on several occasions with cancer symptoms before referral to secondary care. With this as a background we set out to examine what variation existed in the number of pre-referral consultations prior to a diagnosis with cancer.

Luckily for us data from the National Cancer Patient Experience Survey from 2010 had just been made available. This was the first time in ten years that the NHS had undertaken such a national survey of cancer patients, although it has been repeated twice since with the latest results due out soon. What this data set provided was the reported experiences of nearly 70,000 cancer patients. This meant that unlike previous work using smaller samples we could move beyond looking at the “big” four or five cancers and study patients with 24 different cancer types in detail.

And what did we find? Staggeringly large differences between patients with different cancer sites, as well as substantial differences between young and old patients, and between white and ethnic minority patients. Typically only small differences were seen between men and women, but women fared considerably worse than men in the case of bladder cancer. Full details can be found in the paper itself.

The NHS, with free care for all, aspires to providing an equitable service. To what extent the variations we observed represent an underlying inequity or simply reflect the difficulty a GP faces when suspecting cancer is unclear. In any case our analysis provides a framework for identifying patient groups and cancer types in need of further work and/or initiatives to aid diagnosis.

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