New guidelines for urgent referral of patients with cancer are waste of energy

Editor—Guidelines have recently been sent out by the Department of Health for wide consultation in the United Kingdom.¹ The aim is try to reduce mortality from cancer in the United Kingdom by guaranteeing that all patients who present to their general practitioner with symptoms possibly due to cancer are seen in a hospital clinic within two weeks. But there is no evidence whatsoever that delay in diagnosis is a large problem in the United Kingdom. Efforts to implement the so called two week policy are misplaced. The guidelines themselves represent a reasonable distillation from basic medical textbooks, but they are patronising to doctors, who have the longest university training of any professional group. Most copies are likely to end up in the bin.

Those in the United Kingdom know that it continues to lag behind its European neighbours in cancer survival. Politicians must be educated about this rather than be allowed to continue with their obsession about waiting list targets. The whole exercise is reminiscent of the man who loses his keys on the dark side of the road and looks for them under the light across the street. In the United Kingdom the shortage of cancer specialists is more than 500; £1.2bn is needed to bring radiotherapy equipment up to date; and an extra £170m a year is needed for chemotherapy. Facilities for good psychosocial care are few, and people rely heavily on the charity sector for palliative care. The Calman-Hine network is only partially and patchily implemented, with little new funding. There is still gross inequity in the quality of cancer care in the United Kingdom. And there is no National Cancer Centre to set the gold standard.

Ominously for the NHS are the clear signs that there will be major improvements in cancer treatment over the next decade. Next year will see the licensing of herceptin for breast cancer by the European Medicines Evaluation Agency. This will be the forerunner of sophisticated targeted treatments that will require integrated molecular and therapeutic solutions. The human genome project, scheduled for completion in 2003, will lead to new ways of predicting which people are at high risk of developing cancer. In the United Kingdom the basic cancer services need urgently to be put in order to meet these new challenges, allowing British patients to reap the benefits of global progress. If the NHS cannot do it the private sector will—but at a price.

The National Cancer Forum is a derivative of the Calman-Hine group and is convened irregularly. At its most recent meeting this topic was raised, but the forum was told that “ministers have gone too far down the road on this one.” Why? It has never been on the agenda of the forum. During my two years with the World Health Organisation I have visited many countries in different economic environments. Nowhere does a state health department have a two week policy or send out such gratuitous advice to doctors—yet many have better outcomes for cancer care.

Although streamlining the diagnostic process and improving treatment resources makes good sense, these new targets are a waste of energy. Along with NHS Direct and its latest variant—its interactive website—they are simply window dressing. A significant effort to improve the quality of cancer care is essential if we are really going to make an impact and save lives.