Better awareness of cancer symptoms Auditing the diagnosis of cancer

1. Better awareness of cancer symptoms Auditing the diagnosis of cancer Dr Paul Baughan, WoSCAN Primary Care Clinical Lead

2. Auditing the diagnosis of cancer <31 days <62 days Urgent GP Referral Assessment and Diagnosis MDT meeting Commence Treatment

3. Patient notices symptoms Patient reports symptoms Auditing the diagnosis of cancer ? GP decides to refer <31 days <62 days Urgent GP Referral Assessment and Diagnosis MDT meeting Commence Treatment

4. Cancer ‘enhanced services’ Audit 1. Practices must conduct a review of all new cancer cases diagnosed in the previous year, looking at the whole patient pathway from first symptoms to referral. (2007) Audit 2. Practices must conduct a review of all ‘urgent suspected cancer referrals’. (2008)

5. 1. New cancer diagnoses • All mainland Health Boards took part except NHS Tayside and NHS Fife • 78% Scottish GP practices participated • 10 286 new cancers identified and examined during this audit • 2 – 3.5 new cancers / 1000 population identified

6. Time from patient noticing symptoms to presenting with GP Figures based upon 10 286 new cancers diagnosed in Scotland 2007

7. Does gender impact on awareness?

8. Time from presenting with GP to referral Figures based upon 10 286 new cancers diagnosed in Scotland 2007

9. Urgency of initial GP referral (2007) Figures based upon 10 286 new cancers diagnosed in Scotland 2007

10. Why do GPs within some Health Boards refer a greater proportion of their cancers urgently?

11. Audit 2: Urgent suspected cancer referrals (2008) Total urgent referrals per 1000 population / 6mths • Some variation between Health Boards (4 per 1000 population up to 7.5 per 1000 population) • Large variation within individual GP practices (0.5 – 35 urgent referrals per 1000 population)

12. Overall proportion of urgent suspected cancer referrals which complied with Scottish Referral Guidelines for Suspected Cancer • Most likely to follow guidelines with Laryngeal, Lung and Breast cancer (>90% compliance) • Least likely to follow guidelines with Hepatobiliary, Brain, Leukaemia (73-80% compliance)

13. Auditing the diagnosis of cancer in Primary Care - conclusion 1. Important to audit first part of patient pathway if we want to learn how to improve awareness of cancer symptoms 2. Whilst ‘median’ times for patients to present with symptoms are reasonably short, they can be several months for a quarter of the population with certain cancers.3. If we want to diagnose more patients quickly through the ‘urgent referral’ pathway, we may need to significantly increase the total number of urgent referrals. 4. Involving GPs in an audit of their own referrals can be a powerful learning tool at individual, practice and health board level.