A new trial will see the delivery of a full-scale primary care intervention to aid early cancer diagnosis in 80 GP practices across Wales and the Northwest of England; two areas which suffer from relatively poor cancer survival rates due to late cancer diagnosis.
The initiative aims to transform early cancer diagnosis in primary care by introducing new working processes to better inform how primary care considers, and manages, cases of suspected cancer when patients first present to their GP with symptoms.
Over 60% of cancer patients visit their GP when first exhibiting symptoms aligned to cancer, meaning primary care providers have a vital role to play in getting the right referrals and tests, for the right patients, at the right time.
Initial research, funded by Cancer Research Wales and known as WICKED (Wales Interventions and Cancer Knowledge about Early Diagnosis), was trialled across 19 GP practices. It revealed that the use of the national referral guidelines for suspected cancer varied across Wales, and that GPs often felt pressures when they did refer from overwhelmed secondary care services.
Half the GPs surveyed said they lacked confidence in their ability to quickly refer patients with vague symptoms such as unexplained weight loss, loss of appetite, fatigue, and generally feeling different. It was also found there was variation in safety-netting practices across the GP teams. Following the initial research, each practice team made at least 3 changes to their procedures, which included appointing a cancer champion.
These findings were crucial as up to 50 per cent of all cancers diagnosed every year in Wales first present with vague symptoms. The new ThinkCancer! trial will see improved safety netting procedures established – ensuring that patients are continually followed, and test results are quickly actioned and reported on.
It’s hoped the expanded trial will improve cancer services at the first point of patient contact, increase the number and the accuracy of suspected cancer cases, and provide critical evidence to drive policy and practice change – and ultimately boost cancer survival rates through earlier diagnosis.
Professor Clare Wilkinson, of Bangor University, who is research lead for WICKED and ‘ThinkCancer!’, said:
“General practice teams already do excellent work referring patients as early as possible with cancer symptoms or signs. To further improve the current picture, this project will trial a series of bespoke workshops to promote lower referral thresholds and team-wide safety netting practices.”
Dr Lee Campbell, Head of Research, Cancer Research Wales, said, “Cancer symptoms can vary greatly, and are shared with other more prevalent and less serious conditions. Therefore, smarter, and more informed ways of working are required to help suspect and diagnose cancers earlier at the first point of patient contact with GPs.
“This new study is a continuation of the multi-million-pound investment that Cancer Research Wales has made in the field of early cancer diagnosis over the last decade.
“As this intervention is based on the identified needs of GPs and primary care staff across Wales, we would like to thank all those GP surgeries who have worked with us to develop this ground-breaking study. If successful, the study will provide a model that can be replicated across many different disease types.”
Following the initial trial, there was an overwhelmingly positive response, with several practices taking immediate action to improve how their surgeries deal with, and diagnose, cancer.
Nefyn Williams, General Practitioner, at Plas Menai Health Centre in Llanfairfechan, took part in the ThinkCancer! Trial. He said:
“When people come to us with symptoms, we want them to know we’re taking them seriously.
“During the first phase of this trial, the ThinkCancer! intervention encouraged the whole practice team – from clinicians to the patient navigation team - to focus on the early detection of cancer, especially for patients presenting with vague symptoms.
“The earlier we diagnose cancer, the earlier we can start treatment, meaning there is a better chance of curing. This full-scale Stage III trial will help us provide more evidence that this intervention can save lives."
Cleona Jones, GP practice manager of The Practice of Health, Barry, also took part in the initial trial. She added:
“By having everybody involved, from receptionists to staff across the entire practice, we all got to learn, share, and hear everyone’s perspectives on the issue.
“It was a positive experience for us all and has helped us to work as a united front in improving cancer diagnosis in primary care.”
Alastair Richards, CEO, North West Cancer Research said: ‘We are delighted to be working with the Think Cancer Team and Cancer Research Wales on this important project. For patients across Wales and the North West of England it is vital that they receive a diagnosis for their condition at the earliest possible point and equipping GPs and primary care staff with the skills they need to do this is vitally important’.