New guidelines on referring patients with suspected cancer in England and Wales have been launched by the National Institute for Health and Clinical Excellence (NICE). Professor Peter Littlejohns, clinical and public health director at NICE and executive lead for the guidelines, said that the document "will help to ensure that people wherever they live in England and Wales, who present in primary care with suspected cancer will benefit from a consistent and coherent approach which is based on the best available evidence."
The guidelines update previous recommendations from the Department of Health published in 2000, taking account of new evidence from research and from audits. They make recommendations on the diagnostic and referral process for the most common cancers, including lung cancer, breast cancer, skin cancer, upper and lower gastrointestinal cancer, and cancer in children and young people.
For each cancer the guidelines list symptoms that should alert GPs to referring patients either immediately (acute admission or referral within a few hours), urgently (within two weeks), or non-urgently (all other referrals). The recommendations are each graded according to the evidence on which they are based.
Although deaths from some cancers are falling, nearly 140 000 people died from cancer in England and Wales in 2003. A report from the National Audit Office on cancer services in England published last year found that patients in England with cancer of the breast or bowel tended to have more advanced cancer at the time of diagnosis than in some other countries. Older people and those from deprived areas were more likely to have more advanced cancer at diagnosis.
Professor Mike Richards, NHS national cancer director, said, "A key aim for the NHS is improvement in the care of people with cancer, including a reduction in mortality by 20% in people under 75 by 2010 in comparison with a 1995-97 baseline. Progress is being made towards this objective, and death rates are falling. However, there is still some way to go particularly as, for some cancers, survival rates in the UK have compared unfavourably with those in other countries. The NHS Cancer Plan identifies early referral as an important element in the improvement of care for people with cancer. This is, therefore, a particularly important guideline which I am confident will provide the impetus to significantly improve this aspect of the cancer care pathway."
The guideline also covers the support that staff in primary care should offer to people who have symptoms that could be cancer. Offering patients the choice of seeing a male or female GP; proving them with information about the risks and benefits of tests so that they can be involved in making decisions about tests if they wish; and giving details about what to expect when they see a specialist, including their possible diagnosis, are among the recommendations.
Debbie Coats, senior information development nurse, patient representative, and member of CancerBACUP (a European charity providing patients with information), said, "These guidelines will make a big difference to people who are worried that they may have cancer. They will help GPs in England and Wales improve the accuracy and speed of the referral process. They will also ensure that those waiting for their referral appointment are given the information and support they need to help reduce uncertainty during what can be an extremely anxious time. We hope that all GPs are made aware of these guidelines and that they are acted on without delay."
Referral Guidelines for Suspected Cancer are available at www.nice.org.uk.