Six in 10 patients with 'red flag' cancer symptoms in England are not referred to a specialist by their GP quickly enough, a report has found.

Nearly one in 25 of those who were not given an urgent referral in the crucial two-week window went on to develop cancer within a year.

The report by the University of Exeter and University College London said it raises questions about whether GPs' 'clinical judgement is good enough'. 

Experts fear the problem is being ‘exacerbated by the lack of face-to-face appointments’ during the pandemic, with many GPs switching to virtual consultations by telephone or Zoom. 

Early diagnosis of cancer is known to be a major factor in saving lives. 'Red flag' symptoms include difficulties swallowing, iron deficiency, lumps and bleeding. 

Clinical guidelines introduced in England in 2000 state GPs should refer patients with possible cancer to a specialist within 14 days for tests and scans.

Campaigners warned last night the shift away from face-to-face appointments may lead to even more cases of cancer being missed and fewer referrals.

Dennis Reed, of the over-60s group Silver Voices, said: ‘Cancer sufferers already experienced unacceptable delays before the pandemic. This has been vastly accelerated by the pandemic and exacerbated by the lack of face-to-face appointments.’

He added that it was ‘often only through face-to-face appointments that patients open up fully about symptoms and doctors can pick up on warning signs that lead to a cancer referral’.

He said: ‘Some patients can be shy and vulnerable about red-flag symptoms like rectal bleeding or genital issues. They will only open up about these when sat in a room with a doctor, not over the phone or on Zoom.

‘With diseases like skin cancer, there can be worrying growths on the skin that need to be seen in person.’

The study looked at nearly 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral.

It comes as the NHS England waiting list for routine hospital treatment hit 5.6million in July, which has soared since the pandemic hit the UK last March.

Almost half a million people were checked for cancer in June and July, among the highest numbers on record, as the health service attempts to catch up on people who have been missed over the last 18 months.

But nearly 20,000 fewer people than normal with cancer have not yet been diagnosed due to the backlog, according to analysis by the Institute for Public Policy Research and the CF healthcare consultancy.

The study, published in BMJ Quality & Safety, examined how well GPs followed guidelines for cancer referrals and the proportion of patients who weren't referred but subsequently diagnosed with cancer. 

The study looked at nearly 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral.

It comes as the NHS England waiting list for routine hospital treatment hit 5.6million in July, which has soared since the pandemic hit the UK last March.

Almost half a million people were checked for cancer in June and July, among the highest numbers on record, as the health service attempts to catch up on people who have been missed over the last 18 months.

But nearly 20,000 fewer people than normal with cancer have not yet been diagnosed due to the backlog, according to analysis by the Institute for Public Policy Research and the CF healthcare consultancy.

The study, published in BMJ Quality & Safety, examined how well GPs followed guidelines for cancer referrals and the proportion of patients who weren't referred but subsequently diagnosed with cancer. 

Researchers also examined whether certain groups of patients were more likely than others to be referred within the two-week window.

They used a database of anonymised patient records – including hospital referrals and treatment, cancer diagnoses and postcodes – which covered seven per cent of the UK population.

Patients were included if they visited their GP in 2014 and 2015 – the latest data available for cancer diagnoses – with any one of six 'red flag' symptoms.

The symptoms included blood in urine, a breast lump, problems swallowing, iron-deficiency, and postmenopausal or rectal bleeding. 

In total, 48,715 consultations took place where an urgent referral for suspected cancer should have been recommended.

But just 40 per cent of the patients (19,760) were urgently referred within two weeks of seeing their GP.

Of those who were referred, 10 per cent were diagnosed with cancer within the next year.

Meanwhile, 3.6 per cent of those who were not referred were told they had cancer in the following 12 months.

The likelihood of a patient being referred within two weeks varied, depending on which symptom they showed.

The lowest referral rate was for problems swallowing, at just 17 per cent, and the highest was for breast lump, at 68 per cent.

Researchers said there are 'several possible explanations' for why urgent referrals weren't made or recorded, including if patients were admitted to A&E, had an out-of-hours consultation or had already been referred for another condition. 

They wrote: 'Given the proportion of patients going on to be diagnosed with cancer was considerably higher in those receiving an urgent referral than those who did not, we can conclude that GP referral decision-making is not without value.

'However, given the number of patients diagnosed with cancer after non-referral, we may question whether clinical judgement is good enough. 

'In these patients it can be argued that guideline-discordant decision-making may have resulted in a missed opportunity to diagnose early.'

'Stricter adherence to the guidelines and increased awareness of patient groups especially at risk of long diagnostic timelines may help improve early diagnosis and ultimately cancer survival rates.

'Due to the potential impact of regional health services, interventions to reduce guideline discordant behaviour may have more impact if they do not just focus on GPs and individual practices, but also on local diagnostic service provision.'

The average age of patients with the 'red flag' symptoms was 60.

And the most common symptoms were a breast lump (33 per cent) and rectal bleeding (27 per cent).

Most patients had at least one underlying conditions (80 per cent).

And a higher proportion of patients were from deprived areas than expected – 26 per cent rather than a projected 20 per cent.  

And rates varied 'substantially' among different GPs and practices. 

Researchers found that young people aged 18 to 24 and those with a higher number of coexisting conditions were less likely to be urgently referred.

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