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According to yesterday’s headlines, GPs are ‘failing an estimated 32,000 cancer patients a year’ in England.

But those headlines unfairly place the blame at GP surgery doors.

The reports follow a study we funded from a team of scientists based at UCL, The University of Cambridge, The University of Exeter and Public Health England. And while the researchers looked for the number of people diagnosed as an ‘emergency’ who had or hadn’t previously seen a GP, the findings didn’t show that GPs were mostly to blame for these diagnoses by ‘ignoring’ or ‘rejecting’ patients. Or that patients themselves had done anything wrong.

The study included 4647 patients who took part in the 2010 English Cancer Patient Experience Survey and were diagnosed with cancer as an emergency. Researchers then asked if patients had previously seen a GP about their symptoms. And if so, how many times.

The results show that around a third of these patients (34%) hadn’t seen their GP before being diagnosed as an emergency. These ‘emergency’ diagnoses are complicated, as we’ve written about before, and don’t just include people diagnosed after visiting A&E.

Understanding more about cancers diagnosed as an emergency is important, because these patients tend to have later stage disease, and therefore poorer outcomes.

GPs aren’t to blame for most emergency diagnoses

Most of yesterday’s headlines focused on just one of the findings of the study. It states that nearly a quarter of all patients (23%) who were diagnosed as an emergency had seen their GP 3 or more times prior to their diagnosis.

The headlines then suggest that these diagnoses were the fault of the GPs by either missing the patient’s symptoms, or turning them away.

But this is not what this study found. The researchers didn’t look at the reasons behind why these patients were diagnosed as an emergency, or what happened in each GP consultation. In fact the researchers believe the data suggest the opposite is the case. They say the findings don’t represent major failings by GPs because there are many factors at play, which makes diagnosing cancer in these cases incredibly difficult.

Of the 18 different types of cancer included in this study, patients with multiple myeloma (a cancer of the bone marrow) were most likely to have seen their GP 3 or more times. Myeloma symptoms can include persistent back pain, breathlessness and recurrent infections. These are common symptoms that a GP might see a lot and are usually caused by things other than cancer.

So Multiple visits to the GP might be expected, as the GP needs to perform a number of tests to work out what’s going on and rule out other causes.

And for cancers such as breast and endometrial cancer, which can be easier to spot due to more obvious ‘alarm’ symptoms, an emergency diagnosis could also be explained.

The researchers believe that emergency diagnoses in these cases (which represent a small group of patients with those cancers) could be due to them having rarer, less typical symptoms of those cancers.

A third of people diagnosed as an emergency hadn’t seen their GP

But the media coverage missed an equally important finding. This was the previously mentioned third of patients diagnosed as an emergency who hadn’t seen their GP.

Cancer is also a disease with many different types. And sadly many patients, even with common cancers, don’t have symptoms that give much away, until sometimes they become ill and need urgent help

– Dr Georgios Lyratzopoulos

Patients who hadn’t seen their GP prior to an emergency diagnosis were more likely to be male, older (≥85) and from poorer backgrounds. This might suggest that these groups are less likely to see their GP about symptoms. But other research has suggested that’s not the case.

Research that posed hypothetical reasons to people for why they may not visit their GP found that those from poorer backgrounds may indeed select more reasons for not going to a GP. But older people and men were actually less likely to back these hypothetical barriers.

So more work is needed to understand what’s going on here.

Dr Georgios Lyratzopoulos, who led the study in yesterday’s news agrees, saying more needs to be done to identify and tackles things that may prevent people from seeing their doctor.

He adds that the challenge is that some patients may not have had symptoms until just before their emergency diagnosis. And there’s a clue in the data that this may be the case for some patients.

The researchers found that those most likely to present as an emergency with no prior GP visits were patients with brain tumours. Sadly, brain tumours can often be diagnosed with little warning, accompanied with a sudden onset of symptoms, such as a seizure, so an emergency diagnosis in these cases is not unexpected.

Lyratzopoulos adds: “Cancer is also a disease with many different types. And sadly many patients, even with common cancers, don’t have symptoms that give much away, until sometimes they become ill and need urgent help.”

It’s also worth bearing in mind that this study was based on patients diagnosed with cancer in 2010, before much of the recent efforts to improve early diagnosis began, and before new NICE guidelines for GPs on cancer symptoms came out in 2015. So the picture may look different today, with the proportion of patients diagnosed as emergencies after GP consultations becoming even smaller.

That’s something the Royal College of GPs (RCGP) has been quick to point out.

“Those who visit their GP, in the majority of cases, will be diagnosed at a timely stage – 75% of patients found to have cancer are referred after only one or two GP consultations,” said Professor Helen Stokes-Lampard, chair of the RCGP, in a statement.

So while this study doesn’t give all the answers, it highlights the complexity of emergency cancer diagnoses, something we’ve written about before. Research like this can help understand the patterns of emergency diagnoses across different types of cancer and different demographics, so we can work out how to diagnose more people earlier.

“We need to continue to increase awareness of cancer signs and symptoms and help break down the barriers preventing people from seeing their GP earlier,” says Dr Julie Sharp, our head of health information.

And GPs need better access to the right tests and ways of referring patients they suspect may have cancer, which might take more than 1 visit.

Emma Shields is a health information officer at Cancer Research UK

Reference

Abel, G., Mendonca, et al. (2017). Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data. British Journal of General Practice. DOI: 10.3399/bjgp17X690869

Comments

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Sam P June 5, 2017

My father has contacted his g.p. regularly over the last year with blood in urine, back pain feeling, very tired all the time and Breathlessness.
He had mainly telephone consultations and was prescribed diazepam for his back pain with out an examination.
He was sent to the hospital for a chest X-ray over the phone.
He was in so much pain whilst at the hospital for the chest x-ray that my Mum insisted on him seeing a doctor in A&E.
They sent him for a CT scan and PSA blood test and diagnosed advanced prostate cancer with in half an hour of him entering A&E.
That was early March. Because he was diagnosed in A&E he didn’t receive any supportive literature and wasn’t seen by a urologist for two weeks. In fact he was seen when he was admitted through A&E with Fluid in his lungs.
I will let him read this email as I am sure he will be over the moon to know that the GP’s are on top of it and that he must have just imagined the lack of care he was shown over the last year. My daughter is getting married in August. Fingers crossed he might still be here.

Shirley Andrews June 3, 2017

I have no family or friends in my area. Since being operated on for breast cancer 2nd September 2016.Had no support what so ever. I am now waiting for another operation for skin cancer on my face.
If I waited for the referral from GPS. I would not have been seen before 22nd may. Through my own initiative I got a rdv and operated on by the dermatologist.Who showed compassion
I received the results positive on 22nd may.my GPS now realizes I need professional help.I suffer from clinical depression

Tony T June 3, 2017

I have supported your organisation for many years and have always regarded your efforts to inform the public as second to none. Frankly this last publication appears to ignore a number of points.
1) Far too many patients are diagnosed late despite presenting with symptoms known to be cancer indicators.
2) Cancers are far less difficult to diagnose if people are referred to EXPERTS and as we all know; the earlier the better.
3) Understanding and accepting that the absence of evidence is not always evidence of absence…
Given the comments so far perhaps GP’s should err on the side of caution and if and when symptoms represent; fast-track, RE-TEST and monitor. Late referral has nothing to recommend it!! it makes the Consultants job much more difficult, it is far more expensive and unsurprisingly kills people unnecessarily.

Sally June 3, 2017

My Dad repeatedly went to his GP and was told to take Gaviscon for his ‘indigestion. He eventually (after pestering) was sent for a scan and died 6 weeks after diagnosis for Pancreatic Cancer.

Philip Longdon June 2, 2017

Jan Whitaker is correct to point out the long wait for GP appointments. Additionally, my practice no longer has routine appointments after about 1430hrs, – a recent development – and I know from an occasion unrelated to cancer that my (public sector) employer issues written warnings to people attending initial GP consultations during works time. “Fortunately” my Myeloma was discovered fairly quickly, as a very young locum was very through after I fainted and was violently sick on one occasion. Blood tests revealed anaemia and I was seen by a haemotologist less than 48 hours later. MM was confirmed 17 days later and after 5 months of problematic chemo, I have been in “semi remission” and stable for over 3 years.
I think John Hannon is directing his cynicism at the wrong people. The Media industry write headlines and stories, not Researchers, and you only have to look at the Election coverage and any other vaguely political/controversial subject to know that the British Media (even the BBC) are absolutely appalling; They all have their own, populist and prejudiced agenda and headlines rarely even match the stories, never mind the true facts behind them

Peter Yeo June 2, 2017

Twelve years ago my MALE doctor though I may have the early signs of prostate cancer but told me a PSA test was “indicative but not definitive” and therefore did not arrange for me to have one (at a cost of about £7:50 at that time). The took early retirement and his cases were reviewed by a lady doctor in the practice and she immediately had a PSA test done, and that found that I was indeed in the early stages of Prostate cancer. This worried me as my father had died of the cancer 18 years earlier. I was put into the process of further checks, biopsies and treatment, by radiation therapy, and after the course of treatment I was found to be cured, as far as any treatment can effect a cure. I have PSA tests every 6 months and the readings as about as low as it is technically possible to get. Any man who suspects he has a problem should insist that his doctor gives him a PSA test and that the local hospital carries out follow-up action as a matter of urgency as Prostate Cancer is relatively easily treated and cured.

Rocky Andrews June 2, 2017

My beautiful daughter in law had been to the Doctor 6 times and nothing was done, she was taken to A&E and diagnosed within 24 hours. 8 months later she died at 35yrs old. Her young baby was 16 months and she had a very bad cough when giving birth.

Jessica June 2, 2017

Similarly to Pauline Shaw, my late mother (also a Pauline) was fobbed off by her female GP for almost a year. My mother was very body-aware and knew that something wasn’t right but her GP was giving lots of other reasons for why my mother was feeling bloated, indegested, nauseated… acid reflux was the main fobb off. After pushing and pushing and pushing, my mum was finally given an ultrasound and then further tests and guess what was she diagnosed with? Late stages of Ovarian Cancer – the disease was the size of a small grapefruit on one ovary and had started to spread around her body. Needless to say that the GP left the surgery after this, perhaps a guilty conscience?
I don’t like playing the blame game or what if, but I often think back and say that if my mother had been listened to earlier, her chances of survivial would have almost certainly been higher. She fought for 5 long years and much longer than expected, but the C was too aggressive for her body to eventually fight off.
I have heard or read similar stories like this (not on the Daily Mail) and it is worrying. Obviously not all GP’s are like this and the NHS is having money/staff cuts, but surely if a patient is showing potential signs of Cancer, they should be tested immediately to rule it out?

patricia June 2, 2017

My niece’s husband died at the age of 34 because he was wrongly diagnosed by GP with IBS, without any tests, for about 3 years. He became very ill and had to be admitted to hospital where they treated him for (unspecified) infection for two weeks before they finally investigated and found he had bowel cancer, by which time it had become inoperable, he died 5 months later. I signed a petition some while ago to lower the screening age for bowel cancer to 50, I suggested it should be even lower.

Paul Thurtle June 2, 2017

Two months ago my annual PSA blood test gave a high reading. I had a telephone consultation with my GP and she referred me to the hospital. St Peter’s Hospital and Ashford Hospital were fantastic: within days I saw a consultant, had an MRI scan and a biopsy (which did not show signs of prostate cancer).
The NHS were fantastic- just as good as BUPA.
It was me who insisted on an annual PSA blood test as my family has a strong history of prostate cancer. I made sure I attended all my appointments on time and prepared as per the hospital instructions. I had no idea that lots of people don’t bother to turn up and don’t listen to advice given by the hospital.
I am thankful for having a negative cancer result: the message from my consultant was ‘well done for being so proactive’. I am not a naturally pushy person but when it comes to cancer I am.
My message would be if you are worried about cancer tell your GP and make a fuss. The cancer tests are often not pleasant but they are over quickly and no where near as bad as people had told me they were. We all know how important an early diagnosis is.

Pauline Shaw June 2, 2017

I rad you article regarding GP’s missing cancer signs in their patients.
In my case I had visited my GP for 8 months, not once did she examine me, she referred me to the local hospital and then ignored their report which stated my past medical history of cancer my mothers history of cancer and my symptoms indicators of possible cancer.
I was in so much pain I made an appointment with another GP as an emergency who examined me and referred me for a scan within 2 days, 2 weeks later I saw a consultant at the hospital who confirmed I had a grade 3 cancer.
I have made a complaint to my previous GP practice, so far she has blamed me, the original doctor at the hospital and staff on the front desk at the GP practice
for her mistake, taking no responsibility
herself.
My complaint is now with the health ombudsman being investigated by them.

christine hughes June 1, 2017

I do not agree with this when my husband repeatedly went to his gp with symptons which turned out to be pancreatic cancer. He was eventually sent for a CT scan under the 2 week rule but his results were not reported back for a further 3 weeks, his tumour was then deemed inoperable and he died after intensive chemotherapy 12 months later, leaving his family heartbroken

Julie McGonigle June 1, 2017

I hold my mothers GP equally responsible for her death from a curable cancer. His response when asked for an explanation of decisions made of her care took weeks to come and showed not an ounce of regret, empathy or responsibility.

Elsie Gledhill June 1, 2017

Doctors and hospitals did not get my husbands illness at all he was not treated right at all failed by both

Jenny June 1, 2017

My Dad was wrongly diagnosed by his doctor four times. It was a stand in doctor that finally sent my Dad for scans and by that time the cancer had spread, he died 8mths later 😡X

phil palmer June 1, 2017

In the case in my family, the GP practice were unable to provide blood test facility for several days. Therefore the patient was taken to a&e for immediate blood test, which revealed leukaemia.

Jan Whitaker June 1, 2017

Unfortunately it does take too long to even get an appointment to see a GP – 7 weeks and I only got an appointment then because I pleaded. I had cancer 6 years ago but the GP was not interested, eventually I went to a walk-in centre, was sent for the correct tests, diagnosed and treated by the fabulous doctors at the hospital.

Annie June 1, 2017

My sons bowel cancer was missed more than half a dozen times even though he had classic symptoms. The GP ignored all of the symptoms and did NO investigations on the basis that at 26 he was ‘too young’ to have bowel cancer. In the end it was a locum GP who spotted it straight away but it was too late. 17 rounds of chemotherapy, major surgery and internal radiotherapy (that he shouldn’t have had because the cancer had spread too far but the doctors ‘missed it’ on the scan) that left him paralysed for the last 2 weeks of his life was what he endured over the last year of his life. So no, I don’t suppose for a minute that it is ALWAYS the GPs fault but in my sons case it definitely was the fault of the 3 GPs in one practice who missed it, all of whom are still practicing while my precious son is gone. It’s not good enough.

Carly June 1, 2017

Whilst some of this is true the same cannot be said for the situation my dad found himself in. He visited his GP on several occasions over several long months before going to A&E last year. After 2 weeks in hospital and 2 weeks at home he sadly passed away from cancer. Had his GP done his job properly or at least attempted to try and ascertain some of the underlying issues rather than just fobbing him off everytime and throwing painkillers at him he may have had longer with us or at least not had to spend some of his final weeks in hospital while they diagnosed him. Even after his death the GP was completely incompetent and didn’t fill out the death certificate properly causing added and unnecessary stress at an already difficult time for me and my family.

So no, not all GPs fail their patients but on this occasion my dads GP did.

Jodie Mason June 1, 2017

My nan repeatedly went to her GP and actually requested a referral but the GP refused stating she was fine – she was taken by ambulance to hospital and diagnosed with brain and lung cancer that night, and given six months to live. She was failed by that GP and she was made to feel like a nuisance in the run up to that hospital visit. She was only 63 with frequent severe headaches and she was seriously confused about which room was which in her house (she was blind). GPs don’t listen and turn you away, they make you feel like a pest and there isn’t anything you can do about it.

Elaine Hipkiss June 1, 2017

I saw my GP for unexplained bleeding. He immediately sent a referral to hospital. My consultant said he was very on the ball and it turned out to be stage one uterine cancer. I was very lucky and grateful to my GP.

Angela June 1, 2017

My doctor probably saved my life by getting me a range of tests for ibs symptoms, it turned out to be stomach cancer. Just thankful for the tests even though I had to wait for appts.

Ryan June 1, 2017

In my experience not being able to get an appointment at my GP and being fobbed off when I did meant I had to go to A&E as an emergency. I was 29 at the time with advanced bowel cancer but I wasnt treated as a priority because I didn’t fit the profile of what they thought a cancer patients should be.

John Hannon June 1, 2017

I NEVER give information to researchers because, like MP’s, they distort the information to promote their needs and ego.
If I have anything to say about the Dr(s) at the surgery I use, I would say it to their face, not to some headline glory hunting nobody.