Gastrointestinal cancer: why early diagnosis must be a priority for GPs
Gut Health With cancer survival rates in the UK persistently trailing comparable European countries, it’s time to admit to a national problem – and do something about it.
Because so much cancer treatment takes place in hospitals, it is very easy to underestimate the role of family doctors. And as the founding president of the Primary Care Society for Gastroenterology (PCSG), I want to highlight the crucial importance of GPs in one particular area – the early diagnosis of gastroenterological cancers.
Our new PCSG campaign, Think GI Cancer, has just been launched. It encourages GPs to take a more structured approach to patients with suspected cancer.
One vital area is ‘safety netting’ – which, as it sounds, is a way of ensuring that patients with persistent and possibly suspicious symptoms do not slip through the appointments system but always have scheduled follow up consultations.
A lynchpin of the campaign is giving GPs the encouragement and support they need to have frank and honest communications with patients. Doctors must be absolutely clear with patients about why they are being referred for suspected cancer. At the same time, however, they also need to reassure them that their likelihood of cancer is relatively low. It can be a delicate balance to strike but it is essential we get it right.
Why the focus on gastrointestinal (GI) cancers? It’s because, as a whole, they are the largest organ system group of cancers, spanning everything from more common oesophageal and gastric cancers to rarer small-bowel lymphomas and sarcomas.
Around a quarter of UK cancers are still diagnosed only in casualty departments, when the chances are that they will be at an advanced stage and thus harder to treat.
It is only too obvious that many patients are not consulting their GPs early enough and that GPs themselves are not always thinking of the possibility of a cancer diagnosis when they are talking to their patients.
That must change. About one in two of us will get cancer, and one in three of us will die from it. And while screening programmes are widely available, they find only a minority of malignancies, including early stage colonic cancers.
Intense research has tried to identify the delays that may take place along the ‘cancer journey’ – and how to reduce them. Do patients know which symptoms could herald a cancer diagnosis? Where can they get this information – and what is the best way of providing it? How can patients’ anxieties about having cancer be balanced with the inevitable fears associated with referral, tests and investigations – and how can they be helped to realise that they are not ‘wasting the doctor’s time’ when they ask for advice about a change in bowel habit, rectal bleeding or weight loss?
Things are far better than they were. In the 1980s, the focus in general practice was on ‘using time as a therapeutic tool’ and a ‘tolerating uncertainty’ approach. What that meant in practice was the GPs were inactive – and sometimes ignorant. As a result, patients’ lives were sacrificed.
Fortunately, the model today is very different. Symptoms are accurately evaluated in the context of family history, risk factors and medical background, and the threshold for investigation drastically reduced.
Our online campaign aims to make GPs even more effective. They can find out more about it on the PCSG website where we are also providing links to new NICE guidelines and a recent Lancet Commission report.
We hope the information will be accessed by every GP – and not just those with an interest in gastrointestinal cancer. We are also using our meetings, networks and other contacts to promote the aims of prevention, early diagnosis and effective management of GI cancers in general practice to give patients the best possible care and make early cancer diagnosis a healthcare priority now and in the future