Thames Valley Strategic Clinical Network publishes findings of audit to improve early diagnosis of cancer

Thames Valley Strategic Clinical Network (TV SCN) today published the results of a Thames Valley-wide audit of patients diagnosed with cancer after going to hospital following an emergency presentation. The audit also reviewed the entire patient journey for a selected number of these patients.

This significant research project was commissioned by the Thames Valley Strategic Clinical Cancer Network as part of their work to improve cancer outcomes locally and undertaken by Cancer Research UK. The audit was commissioned because it is well recognised that nearly a quarter of people are diagnosed with cancer after attending hospital as an emergency patient and that these patients tend to have poorer outcomes.

Nigel Acheson, Regional Medical Director, NHS England, South, said: “This work has highlighted important steps we can take across health and social care to help patients come forward early so that these cancers can be diagnosed swiftly. Following decades of careful research and the development of new prevention options, we now know that up to 42% of cancer cases could be prevented in the UK. We now understand much more about how environmental exposures and lifestyle choices lead to cancer and the good news is we now have many more ways to avoid these risk factors. For example, sun screens have improved, we have a vaccine to prevent cervical cancer and there are many more products to help people stop smoking. It’s important to be aware of any unexplained changes to your body, such as the sudden appearance of a lump, blood in your urine, or a change to your usual bowel habits and seek early advice and support swiftly from healthcare professionals.”

Six acute hospital trusts (Royal Berkshire Hospitals NHS Foundation Trust, Buckinghamshire Healthcare Trust, Frimley Health NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust, Milton Keynes Hospitals NHS Foundation Trust) and 83 GP practices from Thames Valley (Berkshire, Buckinghamshire and Oxfordshire) Milton Keynes and Swindon, participated in the in-depth audit. GPs from across Thames Valley audited a total of 184 sets of patient case notes who had been diagnosed with cancer in 2012 – 2014 and the whole patient journey was reviewed for 35 of these patients. The audit examined the common themes for those who are diagnosed after an emergency presentation and sought to identify what actions could be taken to diagnose these patients earlier.

Cases were examined by both primary care (GP practices) and secondary care (acute hospitals) carrying out significant event audits on individual patient pathways, with some patients having their experience in both sectors reviewed. Following detailed analysis, the key factors that can influence the likelihood of diagnosis following emergency presentation were identified;

  • Tumour biology (some types of tumour may cause no symptoms at an early stage)
  •  Patient behaviour (not able to recognise symptoms of possible cancers)
  • System issues.

The use of healthcare leading up to cancer diagnosis for those patients whose cases were reviewed in the audit, was also examined to identify ways of improving experiences and outcomes for patients and their carers.

The main findings of the audit report are;

  • Not all emergency presentations of cancer can be prevented. There are some cancers where the first symptoms are sudden and severe causing an emergency presentation with no preceding warning.
  • In a proportion of cases, where there were opportunities for making a diagnosis before emergency presentation, all three factors – tumour biology, patient behaviour and healthcare system factors – individually or in combination contributed to these opportunities being missed. It is not clear whether the prognosis for these patients would have been better, if one of these opportunities had not been missed.
  • Avoidance of emergency presentation through earlier diagnosis contributes to a less traumatic experience for patients and their carers, even if the overall prognosis is not improved.

The findings of the audit will now be shared with healthcare professionals, from both primary and secondary care across Thames Valley initially and latterly with national healthcare partners.

Monique Audifferen, Thames Valley Strategic Cancer Network Manager, said: “We will now work to share our findings with our healthcare partners, public health partners and the public, so that together we can spread the message of the importance of acting quickly on the earliest signs and symptoms of cancer. We will also be working within the healthcare system to share learning around the streamlining of processes between healthcare professionals from different NHS and social care organisations.”

Bridget England, Cancer Research UK’s facilitator manager in the Thames Valley, said: “This audit has been an important process to show how improvements can be made in the early diagnosis of cancer. Cancer Research UK has learnt a lot from being involved. We encourage other networks to carry out similar audits and reflect on the results.”

Find more information about signs and symptoms on the NHS Choices website.