Diagnosing cancer earlier

Two consultants from the University College London Hospital (UCLH) Cancer Collaborative – one of the Cancer Vanguard partners – talk about the work they have been doing to improve diagnosis for suspected cancer patients:

Cancer survival rates in England are higher than they have ever been and earlier diagnosis is the key to improving survival rates further.

At UCLH Cancer Collaborative we recognised there was scope for bridging the gaps in diagnosis. Patients with suspected cancer should all get an urgent referral within two weeks but research shows that only 40% to 45% of patients are diagnosed through this pathway. Others are diagnosed in A&E or in other hospital wards.

Other analysis on cancer patients presenting symptoms in primary care has shown that more than half did not have symptoms in their medical notes that met the NICE guideline for suspicion of cancer. So patients with non-specific but concerning symptoms, such as weight loss and abdominal pain, where the GP suspects cancer, do not have an effective diagnostic pathway.

These patients find themselves going back and forth between GP surgeries and hospital clinics before a diagnosis can be made. Diagnosis takes longer and treatment, which is more effective the earlier we catch the cancer, takes longer too.

As part of the Cancer Vanguard, we have set up Multidisciplinary Diagnostic Centre (MDC) pilots in various parts of the country to deliver a clearly defined and structured diagnostic pathway for patients with abdominal or vague symptoms, where the GP or hospital consultants require quick and profound investigation of patients with non-specific serious symptoms.

We designed the centre to improve patient flow, avoid unnecessary hospital admissions and improve patient experience and outcomes through faster diagnosis.

The concept of MDCs began in Denmark after they recognised that simply having an urgent referral pathway was insufficient to address timely diagnosis of all cancer patients. The evaluation in Denmark is ongoing but remains very positive.

In England, the pilot MDCs are part of the ACE (Accelerate, Co-ordinate and Evaluate) Early Diagnosis Programme, jointly funded by Cancer Research UK, Macmillan and NHS England.

Each MDC has a dedicated team of clinicians, including nurse specialists, who can provide a fast-track diagnostic service for patients who are traditionally difficult to diagnose.

Nurse specialists then provide telephone support from the point of referral, when cancer is suspected but not yet confirmed.

Our MDCs are seeing referrals from GPs rise with a 106% increase between August 2016 and September 2017 and our London sites are reporting more accurate and much faster diagnosis. Of the patients seen by the MDCs, 8% have been diagnosed with cancer and 15% have a significant non-malignant diagnosis (other serious medical conditions). Patient feedback has been very positive, with learning on how the service can improve.

The signs are promising but it is still too early to say what impact this service has had system-wide. The Danish model has reported falls in unplanned admissions and emergency attendance, fewer repeat visits to GPs, and earlier diagnosis of cancer and other complex, long-term conditions.

We hope that the greater the focus on early diagnosis, the higher will be the chances of patients recovering well and living longer.

Andrew Millar

Andrew Millar is a Consultant Gastroenterologist and Hepatologist at the North Middlesex University Hospital where he is the Lead Clinician for Upper GI Cancer, Viral Hepatitis Service and Endoscopy Training.

Andrew led the development the use of Multidisciplinary Diagnostic Centres whilst in post as the London Cancer Hepato-biliary and Pancreatic Pathway Director and has since been appointed as Clinical Lead for Multidisciplinary Diagnostic Centres for the UCLH Cancer Collaborative.

David Graham

David Graham is a Consultant Gastroenterologist at University College Hospital, London.

He has a specialist interest in Barrett’s oesophagus, oesophago-gastric cancer, endoscopic imaging technologies and interventional endoscopy.

David is part of the expert committee devising the BSG guidelines for the management of the pre-malignant and early malignant lesions of the stomach and is part of an international research collaboration looking at ways to improve the early detection of gastric cancer.

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  1. Sophia kiringooba says:

    I work with Andrew Millar at north Middlesex hospital as an MDT Tracker for Gastroenterology. His such a dedicated Dr when it comes to cancer patients.
    Coming across this article where his involvement in increasing early cancer diagnosis is so awesome. He is a big team player at north Middlesex hospital.

  2. syamsul says:

    The cause of cancer has not been fully understood. However, experts believe there are several causes. The first is environmental agents such as the air we breathe, food, drink and cancer-promoting ingredients that the WHO has established such as hydrocarbons in cigarette tar, earth radon gas and solar UV rays. The second cause is virus.

    Several types of viruses have been confirmed as a cause of cancer such as HTLV-I (leukemia and lymphoma), HIV (Kaposi’s Sarcoma), EBV (Burkitt’s lymphoma), Hepatitis B Virus (liver cancer), Type 2 Herpes Simplex Virus, Papilloma Virus (cancer of the cervix, vagina, penis, colon and skin). The latter cause is heredity. For the latter we can not intervene..

  3. Kassander says:

    One of the main RDSs (Rate-Determining Steps) is the difficulty in getting a consultation with the Gatekeeping GP.
    An Appointment? Wait up to 3 weeks
    Book on the day?
    Telephone – no chance
    Queue up in the wind and rain outside a warm populated Practice to be let in to stand in another queue until the Booking computer opens The queue will number 20 – 30 patients but only one receptionist on duty.
    The sooner GPs are taken into the NHS proper and subject to expert management systems the better – at the moment GPs are still in the pre-NHS days in their practices and attitudes to their patients.

  4. Kassander says:

    With the massive advances in medical knowledge and diagnostic techniques, the days of waiting for days to have a 10 minute chat with a GENERAL Practitioner are past, or should be.
    Enough of these “Corner shop” GP set-ups which are only contractors to the NHS proper.
    Time for some real professionalizm, the days of
    “The Black Bag” are long gone.