On November 6th, Professor Roger Jones, founding president of the Primary Care Society for Gastroenterology who holds an emeritus post at King’s College London, launched a campaign that highlights the crucial importance of family doctors in early gastroenterological cancer diagnosis and seeks to clarify how they can best help their patients.
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, says a leading expert at the Primary Care Society for Gastroenterology (PCSG).
Appropriately so, says Professor Jones, as gastrointestinal (GI) cancers, as a whole, are the largest organ system group of cancers, spanning everything from more common oesophageal and gastric cancers to more rare small-bowel lymphomas and sarcomas.
To support the launch the Annual Scientific Meeting included a number of talks on gastrointestinal cancer from leading lights in the field, such as Professor Greg Rubin and Professor David Kerrigan (see below). The launch was also supported by the presence of a 25ft inflatable colon, to be offered to GP surgeries as an educational tool.
Professor Jones praised NICE’s recently updated guidance on suspected cancer which is reported to have the potential to save up to 5,000 lives a year by introducing the two-week wait for cancer referrals in England and Wales. He also highlighted the importance of the new Lancet Commission report on the expanded role of primary care in cancer control.
The PCSG campaign encourages GPs to take a more structured approach to any patients with suspected cancer.
‘Safety netting’, ensuring that follow up appointments are scheduled for anyone with persistent and possibly suspicious symptoms is a lynchpin of the campaign, coupled with encouragement and support for GPs to have frank and honest communications with patients.
‘We need doctors to be absolutely clear with patients about why they are being referred for suspected cancer, while at the same time attempting to reassure them that their likelihood of cancer is relatively low,’ says Professor Jones
With around a quarter of UK cancers still diagnosed only in casualty departments, 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.
Yet 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. Instead, most are diagnosed either after presentation by symptomatic patients to general practitioners or, worryingly, as acute presentations at hospital emergency departments.
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?
‘In the 1980s, the paradigm of diagnosis in general practice was all focused on “using time as a therapeutic tool” and “tolerating uncertainty” approach, in which patients’ lives were sacrificed through the inactivity and ignorance of GPs,’ says Roger Jones.
‘That’s moved to a model today where symptoms are accurately evaluated in the context of family history, risk factors and medical background, and the threshold for investigation drastically reduced.’
The PCSG website that targets GPs aims to underpin the campaign with news, resources and links including the NICE guidelines and the Lancet Commission report.
‘We want it to be readily accessed by GPs with an interest in gastrointestinal cancer,’ says Professor Jones. ‘We’ll use our meetings, networks and other contacts to promote the aims of prevention, early diagnosis and effective management of GI cancers in general practice and primary care to help make it happen.’