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NICE Is Updating Its Guideline on Suspected Cancer to Help GPs Spot the Early Signs and Symptoms of Cancer

24 Nov 2014
Bioethics, legal and economic issues

Around 300,000 people were diagnosed with cancer in England and Wales in 2011. The best way of tackling the disease is for patients to receive an early diagnosis, as this improves the chances of beating cancer. If cancer is caught at an early stage before the disease has spread, treatment is more likely to be successful.

Yet not enough is currently being done in England to identify cancer and treat it an early stage. Up to 10,000 people in England could be dying each year due to late diagnoses.

Reasons why cancer diagnoses may be missed include that many different types of cancer exist, each with different symptoms, and that patients present at primary care with symptoms that are non-specific.

For example, many people who smoke may have a cough associated with chronic lung disease, but the same people may dismiss those symptoms as normal for them.
Signs of cancer may also not be clear or obvious and GPs see, on average, only around eight new cases a year. A full time GP will have between 6,000-8,000 appointments every year. And they will only have around 10 minutes per appointment to pick out warning signs that could be cancer, but equally may be a symptom of a less serious condition.

To help GPs ensure they are making prompt and accurate diagnoses, NICE (National Institute for Health and Care Excellence) has updated its suspected cancer guideline and has included a number of tables which link symptoms to the cancers they are associated with.

For example, if a patient is over 50 and presents with unexplained rectal bleeding, NICE says that this could be linked to colorectal cancer and sets out a recommendation for referral. Or to consider a suspected cancer pathway referral for colorectal cancer in people aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings: abdominal pain or change in bowel habit or, weight loss, or iron-deficiency anaemia.

The guideline also sets out the time frame for which referral patients should be referred to a specialist. This ranges from 48 hours to 2 weeks, depending on urgency.
New recommendations for 2015 also cover patient information and support and safety netting.

NICE recommends considering a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet criteria for referral or other investigative action.

This review may be planned within a time frame agreed with the person, or patient-initiated if their symptoms recur, persist or worsen, or new symptoms develop or the person continues to be concerned.

The NICE hope this will help realise ambition to see three-quarters of people surviving the disease within the next 20 years.
Public consultation on the draft guideline will run until Friday 9 January 2015.

All relevant patient groups and organisations, including local Clinical Commissioning Groups and other GP-led bodies, are encouraged to register an interest in the guideline and submit comments via the NICE website during this consultation period.

Last update: 24 Nov 2014

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