Dr Richard Roope, a practising GP and Clinical Lead for Cancer at Cancer Research UK and the Royal College of General Practice, shares his thoughts on challenges and opportunities in diagnosing cancer earlier.
As GPs, we know that too many of our patients worry about wasting our time – a point underlined by a recent Cancer Research UK-funded study.
We also know that patients in this country are more likely to worry about seeing us when they have symptoms, and perhaps put off seeing us for longer, than elsewhere. And this is felt to be one of the many factors that contribute to the UK’s relatively poor cancer outcomes, compared against similar health systems both in Europe and further afield.
Diagnosing patients earlier has a big impact on their outcomes. For example more than 9 out of ten patients (93 per cent) diagnosed with bowel cancer at the earliest stage survive for 5 years or more, compared with below one in ten (7 per cent) in the most advanced stage of the condition.
On top of this, for the four cancer types where we have data, the financial cost of treating at an early stage early is nearly two-and-a-half times lower of that of treatment at the later stages.
So, how can we – as a country – do better?
A helping hand?
The challenge facing both GPs, and our patients, is identifying when someone needs to seek advice regards their symptoms. GPs are seeing many patients that have concerns about their symptoms – particularly during the winter months – and yet there are still patients with potentially serious symptoms who we are not seeing.
We need to think of novel ways to address this. In the current era of easy access to all manner of information via the Internet, social media, surgery websites etc, there is plenty of opportunity to empower people to seek advice, and raise awareness of key cancer symptoms. And although we need to be mindful of widening the gap between rich and poor, the uptake of smartphones across social divides is encouraging.
And over the past four years, the Be Clear on Cancer campaigns have tried to address the issue with both targeted campaigns – such as the “Blood in Pee” and the current “Three weeks of heartburn” – and other more general campaigns. Results have been encouraging, notably for the “Three week cough” campaign.
As GPs we should be reinforcing appropriate consulting behaviour– for example, coming to see us when people notice something persistent or unusual, such as a cough that won’t go away – and encouraging patients to take advantage of the other types of services available to them. Pharmacies, for example, are a largely untapped resource – while most surgeries offer telephone consultations with both GPs and practice nurses.
We also need to encourage our patients to seek advice about their symptoms if they’re worried. This can be done by providing information in the practice leaflet, on the practice website and having information posters on the practice notice boards.
A caring profession
Underpinning all of this: GPs are a caring profession, albeit a time challenged one. But in the long run it will save everyone time if we are approachable and listen to our patients and their concerns.
I remember being taught at medical school that the patient has only wasted their GP’s time if they feel they have wasted their own. As we clinicians reflect on our consulting skills and the performance of the NHS as a whole, we should be aware of the rather challenging statistic: half of all cancer patients are currently diagnosed at a late stage.
So one of the challenges for all of us is for the public to be both up-skilled in cancer awareness, and empowered to access the right person – be that a GP, a nurse, a pharmacist, or the expertise on offer at walk-in centres – at the right time.
GPs, like all in caring professions, want to make a difference to our patients and their families – and we are best able to do this if patients know that they can, and should, see us when they need us.
Jane Canessa May 4, 2015
It would be useful to know how you can make a doctor’s receptionist realise that you have worrying symptoms and need an appointment quickly. In my surgery it’s usually at least a week until you are offered an appointment. Any training for receptionists in the pipeline?
Mrs Lilley April 26, 2015
Early detection is o.k. if the Doctor acts on it quickly enough. On a different note I had a time when I had to wait 2-3wks at least for the results that is heart rendering. Especially when, like me, at the end of that time, I was told it was a ‘shadow on my lung’ not (thankfully) lung cancer. My mother had passed away near that time with Lung Cancer and I had to go the same Hospital Clinic and remember all that she had gone through too. I was a wreck for months. Surely a telephone call from the Consultant wouldn’t go amiss in situations like that? But I totally agree that people should see their doctors asap if they note any alteration of the body. After having friends and family going through Cancer Treatment some ‘picked up earlier than others’. I can see the difference. However Doctors need to listen more to the patient when THEY know that something is ‘just not right’ with a particular part of their body. It’s too often that I see young people wrongly diagnosed only to be told too late that they have Cancer – some which could have been ‘picked up earlier’ with the patient able to recover short term or longer. This applies to elder people also obviously. But I do see, in the media, that more younger people are being told that ‘it is nothing to worry about’ etc. e.g. ovarian cancer for which I had ‘cancer cells’ removed by having an hysterectomy after years of suffering. I had to use the ‘Broken record Syndrome’ before I got the help I needed.
allison morris April 25, 2015
i am really sorry to have to be so negative to this post my cancer was misdiagnosed by a whole group practice of gps so please do not put the blame on the patient .. i can inform you of more details at a later date if you so wish to know them. Please cancer research more education for the local gp.. i had a tumour in my arm measuring six inches by 4 inches inches my arm was bent at 45 degrees by the time anybody took any notice of me .please feel free to contact me..
Madeline April 24, 2015
I have ovarian cancer, finally diagnosed 9 months after I first went to GP. Initially GP was quick to refer me BUT sent a copy of a year old ultrasound scan to Gynaecologist. He examined me and pronounced ‘it’s not ovarian cancer’ very categorically. I asked if I should have another scan – he dismissed necessity of this. Sent a very complacent letter suggesting GP retest blood marker in 2 months as it was only very slightly raised. GP made no note of this and did not call me back and, convinced I was fine, I did not follow it up. For some reason my original symptoms had vanished too at that point! By time symptoms returned went back but even then scans were misread and told I had a benign tumour. I pushed for bringing laparoscopy forward and only then was cancer found. Again, I was 48 so it was ‘not likely’ at my age but have since heard of numerous cases in 40’s and even younger. I’ve had surgery and chemo but told v likely it will relapse and need more chemo. I think cancer should be ruled out FIRST and then look at other possible causes and not the other way round.
Jan April 24, 2015
My husband approached his GP numerous times and for more than a year was sent for blood test after blood test for everything except Prostate cancer which he had. By the time he was sent to hospital for proper investigations (and told by the GP ‘ not to come out until they find out what’s wrong with you’) the cancer had spread to his pelvis and spine and there is now no cure. The GP told him that he ‘should have made more fuss’.
David April 23, 2015
When I had a recent scare my GP referred me to my local hospital. I had tests and examinations within 2 weeks. Thankfully it wasn’t cancer and I am being treated with medication. Can’t speak for other doctors but my NHS doctor is brilliant.
Peter Abrahams April 23, 2015
Early diagnosis is important but the GP has got to get it right too.
My wife went to her GP complaining of excessive fatigue, a blood test was arranged and an appointment to the fatigue clinic was arranged for a couple of months out.
My wife then complained about stomach pains went private and was diagnosed with colon cancer that had spread to the liver.
In the waiting room of the NHS GP was a poster saying that one of the signs of bowel cancer was fatigue. Why was the relevant test for bowel cancer not done?
RITA MASTERS April 23, 2015
Docs do not listen. My sister was miss diagnosed for 3 months and has lung cancer
Martin Brignall April 23, 2015
Far too many people are dying because they are not being referred early enough by their GPs – despite seeing their GP at an early stage of noticing symptoms correctly.
There is a lot of work to be done to ensure that patients are referred promptly and not put off – to ‘save money’ or for whatever other reason not directly clinical.
To many deaths are happening because of doctors’ faults – not at all down to patients seeking help at late stages.
This is covered up, of course.
Steve Cooper April 23, 2015
It’s Ok saying this however my dad had heartburn for over 15 years and visited the doctor numerous times. Each time the doctor gave medication and sent him away. He has now passed away from Oesophageal Cancer! I just hope GP’s take note of campaigns like the heartburn one stating over 3 weeks, see a doctor! My dad did!!
Margaret Fairbairn April 23, 2015
i went to doctor first in September with a pain in my side. it was January before i was diagnosed with kidney cancer and it had spread to my spine. the worst day was when the cancer fractured my spine. now I am dying.
Teresa April 23, 2015
My husband had constant stomach pains and constant tests yet his stomach cancer was not found until too late!
Mrs. Goolmohr Cantel April 23, 2015
Bravo! People need to be made aware of the advantages (life over death) of early detection. Newspapers, magazines, Internet and new technology should be used to tell people what to watch out for at an early stage. Yes, people don’t want to worry their GPs, as often they don’t receive proper support. People SHOULD be more aware of what early cancer signs are like and TO TAKE ACTION. A lot of people don’t use the Internet, so there should also be other ways to inform them too. Tell them it is vital that they take notice of very early symptoms and not to be shy to seek medical expertise.
Violet Harper April 23, 2015
I also think GP’s should not assume that if a patient is young then it will not be cancer as, sadly, we read all too often the young are affected.I’m middle aged but have had symtoms that alerted me to ask to be checked for bowl cancer. I first went 16mths ago, Gp just felt my abdomen externally & decided with just that most basic examination that ” It is probably diverticulitis” gave me antibiotics which didn’t help & that was that. Now, I appreciate that her training & experience was MAYBE enough but given I’m middle aged & cancer is common in my family I should have had further tests? I continued to be symtomatic so I returned earlier this year & a different GP ran blood tests which thankfully were clear but as I am still having unpleasant symtoms I am being referred which will be many weeks. I just hope very much that there is nothing found as it will be, in all probability, over 18months from my original visit!
Agnes watt April 23, 2015
My daughter just 24 went to gp about a lump in her right breast in December he said he would referl her she went back January seen other gp how would chase up the referl middle of January her phoned the hospital herself to be told that they have just received the referl appointment for March came in February. She was dienosed with grade 3 ibc had about 10 different tests before her chemotherapy started 18 weeks then surgery then radiotherapy.
Amy April 23, 2015
Although sometimes the patients are reluctant to go to their GPs, at times the ‘blame’ can be passed on the GPs. My 35 year old sister went to her GP for six years and was treated for IBS. Despite having all the symptoms of bowel cancer (and a family history!) they refused to refer her. Eventually after demanding enough times she was referred to a specialist, but so late that she has since been diagnosed with stage three bowel cancer. I understand that bowel cancer is rare in younger people, but symptoms before age should be the rule! I understand that GPs cannot be experts at every medical issue, but if someone comes with the same complaint for two years then surely they should be referred to a specialist, no matter their age.
Michael Brand April 23, 2015
No doubt most GPs are well intentioned, but the reality is they are poorly equipped to make early cancer diagnoses. The standard 10 minute GP appointment is simply not adequate for a clinical examination which might detect a cancer at an early stage. It is only when the cancer is advanced and symptoms are blindingly obvious that a GP might make the diagnosis, and then it is too late. What we need are inexpensive, non-invasive diagnostic tools for early stage cancers. There is a huge amount of research in biosensors taking palce worldwide to solve this problem. Sensor100 is launching a project to identify and promote the best of this work. To stay informed, sign up for oor newsletter at the link below.
helen wright April 23, 2015
This article purely relates to a patient feeling scared about seeing their gp for early diagnosis… this is NOT always the case. Gps don’t always have an indepth knowlegde on a subject or they have not kept themselves updated on research etc. If a patient presents with ‘cancer like’ symptoms surely they could ask a colleague within the practice for their advice/guidence. My husband presented with a mole on his lower leg – gp refused to refer him to a plastic surgeon for eight months. My husband went to the gp three times before he insisted gp referred him to a consultant. My husband died at 36.
Sharon April 23, 2015
I think GPs need to refer patients sooner – better safe than sorry. My mum had bowel cancer but was initially told by her GP it was piles and given all sorts of treatement for piles/haemorrhoids, none of which worked. After 6mths of getting nowhere with her GP she paid for a private consultation and was rushed in the following week for a major operation as she had bowel cancer! I went to my GP back in May 2014 regarding a mole that had grown and was told it definitely wasn’t cancerous/nothing to worry about. I asked for it to be removed in December as it was getting in the way only to discover it was cancerous and I now have advanced melanoma – I just wish I’d pushed for a referral back in May last year. So, my advice to everyone is to push for a referral if you’re fobbed off by your GP – see a specialist who knows what they’re talking about.
Margaret Bishop April 23, 2015
GP’s need to take younger people more seriously when they do come forward with concerns. Bowel cancer affects young people who are not overweight and do plenty of exercise. My son was told his symptoms were IBS on more than one occasion and died at the age of 32 with inoperable bowel cancer due to late diagnosis. We were told they would not have expected it in someone of his age! Time to seriously rethink!
Mrs I April 23, 2015
GP’s need to be mindful of how we, as patients feel. In the last few months I have seen the same GP 4x regarding my daughters health. ALL four occasions the first words out of her mouth have been ‘ you only have ten minutes’….feeling rushed and under pressure the moment you walk in is not helpful – it adds to stress. We all know GP’s are busy BUT they should make time for each patient and not rush them.
Jan Pope April 4, 2015
GPs need to end consultations that have been inconclusive with a ‘come back and see me’ or ‘I’ll see you again in 2 weeks/2 months’, or whatever, giving the patient permission to ‘bother the doctor’.
That’s all it took for my husband to pursue his symptoms (our own GP was less accommodating and he had seen someone else this time) and the result was a head and neck cancer.