Early Diagnosis & Assessment
Earlier awareness, detection and assessment is crucial to enable a greater prospect of survival and improved quality of life for those experience cancer symptoms or a diagnosis.
Awareness & Support
Societal and behavioural norms can delay in getting medical help when faced with possible symptoms; fear of what a doctor may find, worry about wasting practitioner’s time, lack of knowledge about specific cancer signs and symptoms and an inability to book a GP appointment can all contribute to presentation at a GP.
a dual focus on primary care education and appropriate/prompt referrals from primary care are key to driving this agenda
Earlier diagnosis has the greatest potential for improving outcomes and survival. Variation exists across the region which helps identify this opportunity. The implication of earlier diagnosis is “ramped up” diagnostic referral volumes to match the demand.
While under 75 mortality rates across Thames Valley are average, early detection remains a high priority as 1 year survival rates could be much improved (click for data)
Improvement in staging has been seen across the whole TV region, with South Reading and Wokingham CCGs seeing the biggest improvements in staging coverage (click for data)
Case mix of cancers being detected at an early stage will have an impact on the proportion of early cancer detection. Breast is more likely to be detected at an early stage, vs Lung so areas with higher proportion of breast cancers will have better outcomes than those with higher proportion of lung (click for data)
Insufficient Capacity for Diagnostics in Thames Valley
Rising demand for referrals in secondary care is playing a role in the increasing time it takes to reach diagnosis.
England’s rates of endoscopy for lower gastrointestinal cancers per 100,000 population lag behind comparable countries. Endoscopy services themselves, also vary in quality with many not JAG accredited (the marker of a quality service) and some patients experiencing 6+ and 13+ week waits for endoscopy. The impact of this is felt in England’s poorer cancer outcomes for bowel cancer than in comparable countries.
Thames Valley SCN completed a cancer diagnosis demand & capacity project in March 2016- full details and reports including the modelling tool can be accessed from the link opposite.
Top Line findings of the report
Between now and 2021, suspected cancer referrals will rise between 7 and 31% in the Thames Valley
Preparation for implementation of the 28 day cancer standard (from 2020) highlights current performance across Thames Valley is poor (click for data)
Upper Gastroenterology & Urology (per CCG)
Lung & Skin (per CCG)
Head/Neck & Lower GI
Breast & Gynaecology (per CCG)
GP direct access requests only account for 1/4 of all tests used to diagnose or discount cancer. This will significantly increase once all pathways are developed in accordance to NICE guidance (click for access)
Supporting Actions to achieve Early Diagnosis & Assessment Ambitions
- Commission locally-developed awareness campaigns to improver earlier detection of cancer, for example the London Get to know Cancer pop up shop and cancer activist programmes
- Contact Macmillan to access the free Cancer Decision Support Tool: firstname.lastname@example.org
- Invest in CCG GP Cancer leads to provide local leadership and co-ordination for early detection activities.
- Request your Provider Trust stages at least 70% of all cancers
- Access advice & guidance for GPs from the Cancer SCN Primary Care Resource Toolkit
- Commission sufficient capacity to manage national Be Clear on Cancer campaigns – see details of current and upcoming campaigns
- Commission additional endoscopy capacity for lower gastrointestinal cancers ensuring only JAG accredited providers are used
- Request your Provider Trust books the 1st Outpatient appointment for 2week wait referrals within 5 working days
- Commission in accordance with the pathways agreed by the Thames Valley Cancer Network