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GPs spot 80% of cancers within two consultations, audit shows

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f772 (Published 07 February 2013) Cite this as: BMJ 2013;346:f772
  1. Susan Mayor
  1. 1London

GPs refer more than three quarters of people who go on to receive a diagnosis of cancer after only one or two consultations, shows an audit of cancer diagnosis in England. The audit concludes that the number of consultations is a useful indicator of the time interval between a patient presenting with cancer symptoms and being referred to see a specialist.1

But the results show that GPs have more consultations with patients who have cancers with non-specific symptoms, including multiple myeloma and stomach and lung cancer, typically seeing them at least three times before referring them to a specialist.

The researchers analysed data in the national audit of cancer diagnosis in primary care from 13 035 patients with 18 different cancers diagnosed in 2009-10. They looked at how the number of GP consultations before referral to a specialist was associated with the time interval from when patients first presented with symptoms to when they were referred, as part of finding strategies to diagnose cancers earlier.

Their results showed that most of the patients were referred after only one (56% of patients) or two (25%) consultations with a GP. The median time from first presenting with symptoms to being referred to a specialist was zero days among those who saw their GP once (the referral letter being sent on the day of presentation), while the interval was 15 days among patients seeing their GP twice.

“Much is assumed about GPs spotting cancer late, but these data show that in the great majority of cancers the suspicion is made promptly,” said the lead author, Georgios Lyratzopoulos, National Institute for Health Research postdoctoral research fellow at the Cambridge Centre for Health Services Research, Cambridge University.

But nearly one in 10 patients (9%) had three consultations with their GP before being referred, 4% had four consultations, and 5% had five or more. The median times between first presenting and being referred to a specialist among these patients were 34, 47, and 97 days, respectively.

Patients with multiple myeloma and lung cancer were especially likely to have three or more GP consultations before referral (46% and 33% of these patients, respectively) and the longest intervals between presentation with symptoms and a specialist referral (21 and 14 days). People with breast cancer and melanoma had the lowest number of primary care consultations and the shortest intervals before seeing a specialist (zero days for both).

The researchers said that their findings showed that the number of pre-referral GP consultations was valid as a measure of the delay between a patient with cancer first presenting with symptoms and being referred to a specialist (Spearman’s correlation coefficient 0.7).

“Reducing the number of pre-referral consultations can result in a more timely diagnosis of cancer,” said the coauthor Greg Rubin, Cancer Research UK’s clinical lead on cancer. He said, “We need to consider ways of making the process of primary care assessment even smarter, for instance by wider use of clinical decision support tools or more efficient investigation pathways.”

Notes

Cite this as: BMJ 2013;346:f772

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