Intended for healthcare professionals


Why can’t we improve the timeliness of cancer diagnosis in children, teenagers, and young adults?

BMJ 2013; 347 doi: (Published 29 October 2013) Cite this as: BMJ 2013;347:f6493
  1. Lorna A Fern, research manager1,
  2. Rebecca Birch, research associate2,
  3. Jeremy Whelan, professor of cancer medicine and clinical oncologist3,
  4. Mathew Cooke, lay representative4,
  5. Stephen Sutton, lay representative 4,
  6. Richard D Neal, professor of primary care medicine5,
  7. Craig Gerrand, consultant orthopaedic surgeon6,
  8. Gill Hubbard, reader and co-director7,
  9. Sam Smith, head of nursing and quality8,
  10. Chris Lethaby, specialist registrar9,
  11. Rachel Dommett, academic clinical lecturer in paediatric oncology 10,
  12. Faith Gibson, clinical professor of children and young people’s cancer care11
  1. 1National Cancer Research Institute Teenage and Young Adult Clinical Studies Group, Department of Oncology, University College London Hospitals, LondonNW1 2PG, UK
  2. 2Faculty of Health and Social Care, Department of Children’s Nursing, London South Bank University, London, UK
  3. 3Department of Oncology, University College London Hospitals, London
  4. 4Consumer Liaison Group, National Cancer Research Network, London, UK
  5. 5North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
  6. 6North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
  7. 7Cancer Care Research Centre, School of Nursing Midwifery and Health, University of Stirling, Stirling, UK
  8. 8Teenage Cancer Trust, London, UK
  9. 9Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
  10. 10University of Bristol, UHB Education Centre, Bristol, UK
  11. 11Great Ormond Street Hospital for Children NHS Foundation Trust and London South Bank University, London UK
  1. lorna.fern{at}

A comprehensive programme of research is needed to find out

More than a third of young people attending this year’s Teenage Cancer Trust conference, “find your sense of tumour,” were diagnosed through emergency presentation, with a quarter having previously visited their general practitioner with symptoms. This has resulted in a considerable amount of “GP bashing” by young people and an angry but passionate call for interventions to improve the timeliness of cancer diagnosis. The problem seems to be real, but the research evidence is missing.

In the United Kingdom, five year cancer survival for children and young people (0-24 years) varies between 50% and 95%, with survival in some cancers hardly having improved over the past two decades.1 2 Although cancer is the leading cause of death from disease in this age group, it is rare—around 3500 cases a year. Morbidity from both the treatment and disease is considerable, and interruptions to social development, education, and employment are likely. Caring for a child or young person with cancer can cause serious stress within the family, and the economic consequences for the family and society are considerable.

Evidence exists that children and …

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