Widespread cancer care variation means 20,000 patients miss out on early diagnosis

Nearly 20,000 people every two years are missing out on early cancer diagnosis because of widespread variation of treatment in England, Cancer Research UK (CRUK) has found.

Analysing Public Health England data from 2012-13, the charity found that almost half the cancer patients in Merseyside, for example, are diagnosed late – compared to 40% of patients in the south west. Though both statistics are high, survival for some of the most common types of cancer is around three times higher when the disease is detected in earlier stages (1 and 2).

If Merseyside care was as good as treatment in south-west England, almost 1,000 more cancer patients would have had an earlier diagnosis and a bigger chance of beating the disease.

Breaking down the figures into specific cancers, the organisation found that in London, almost a quarter of breast cancer patients were diagnosed late. This compares to just 10% in Leicestershire and Lincolnshire – meaning around 1,000 Londoners are missing out on early diagnosis.

With bowel cancer, Merseyside was also at the bottom of the list, with nearly 60% of its patients diagnosed late compared to half of bowel cancer patients in East Anglia.

But not only was variation common across regions, it was also linked to the type of cancer itself. East Anglia, for example, came on top in regards to detecting bowel cancer at an early stage, but was almost the worst region for spotting melanoma skin cancer.

Sara Hiom, director of early diagnosis at CRUK, said: “It’s unacceptable to see such variation across England, with some areas falling far behind others in prompt diagnosis of different cancers.

“The available data indicate widespread problems, with far too many patients being diagnosed later than they should be.”

She added that it is vitally important to support GPs in the diagnosis of cancer and cited resources that help ensure patients are investigated promptly.

“The new cancer strategy makes clear recommendations on how we can improve England’s cancer survival, and improvement is needed across the whole of the UK,” Hiom continued.

Dr Maureen Baker, chair of the Royal College of GPs, agreed that more needed to be done, but argued that GPs were already doing a good job of referring patients to cancer treatments.

“The variation in early diagnosis could be due to a number of reasons including population characteristics, the numbers of patients presenting with symptoms that could potentially be cancer, and local hospital administration systems – not simply GP referral – and these all need to be addressed,” she added.

Mentioning that 75% of cancers were detected after being referred after one or two GP consultations, Baker continued: “Giving family doctors right across the UK better access to diagnostic tools, such as MRI and CT scans and ultrasounds, would inevitably improve this event further, and this must be a priority. By investing in general practice – including access to diagnostics – now, we will be able to save both money and our patients’ misery in the future.”

And ahead of the National Cancer Research Institute’s annual conference in Liverpool next week, Harpal Kumar, the organisation’s chief executive and chair of the National Awareness and Early Diagnosis Initiative, said: “These figures show much more needs to be done to give patients the best chance of surviving their disease in all areas of the country.

“The government has promised to act on the recent cancer strategy for England, which I published in the summer. I urge it to commit to the full package of recommendations as quickly as possible to get the best possible outcomes for all cancer patients.”

The research also follows several warnings this year that the state service’s ability to diagnose cancer patients early was waning.

In August, it emerged that thousands of patients were missing out on critical molecular diagnostic tests in NHS hospitals. Over 24,000 tests were not undertaken, representing a 41% gap from the demand of nearly 60,000 tests.

Just a week before that, data from NHS England revealed that the NHS was failing to meet key performance targets, with two of the eight outlined cancer standards being unsatisfactory. This included the 62-day cancer waiting times and two-week waiting times for potential breast systems.

This came less than a month after a September study, also by CRUK scientists, found that patients who have to see a GP more than three times before being referred for cancer tests are more likely to be dissatisfied with their overall care.


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