Improving pancreatic cancer outcomes

GPs need clearer referral pathways, argues Dr Ian Watson.

Metastatic pancreatic cancer: CT scan showing cancer (green dots) in the pancreas and liver (Photograph: Du Cane Medical Imaging Ltd/Science Photo Library)
Metastatic pancreatic cancer: CT scan showing cancer (green dots) in the pancreas and liver (Photograph: Du Cane Medical Imaging Ltd/Science Photo Library)

As a GP, any efforts to raise public awareness of a disease can make the heart sink at the prospect of having to reassure those patients with overactive imaginations who think they are dying.

On the other hand, pancreatic cancer is without a doubt a disease that has not received its fair share of attention. More than 8,350 people a year are diagnosed with the disease and about 7,900 a year die from it.

Pancreatic cancer is particularly challenging because symptoms can be non-specific and by the time it is diagnosed, it is often too late to be treated.

Many patients die within six months of diagnosis and only about 4% live for five years or more. It is a lethal cancer, representing the fifth most common cause of cancer deaths in the UK after lung, bowel, breast and prostate cancers.

Most of us know, through our personal or our professional life, someone who has died of pancreatic cancer. On both a personal and a professional level, I support initiatives that could make a positive difference to this disease.

Last year, I attended the Early Diagnosis Summit on pancreatic cancer organised by national charity Pancreatic Cancer UK.

I was encouraged to learn that some progress is being made to identify pancreatic cancer symptoms and offer greater insight into how patients present leading up to the point of diagnosis.

Even better, there are tools now available that would greatly help GPs to identify patients where there may be some cause for concern.

Non-specific symptoms

I was, however, struck by the fact that one of the key challenges GPs continue to face with a disease like pancreatic cancer is what to do for patients who have non-specific, persistent symptoms, or where we have a high degree of suspicion that something is not right, but no obvious sign of what that might be.

There was a time when communication between GPs and secondary care clinicians was such that a quick telephone call with a consultant we knew well was easily arranged - not so in today's modern NHS.

Furthermore, as secondary care clinicians have rightly moved towards being specialists, referral pathways have followed suit.

For the woman with a breast lump or the patient with a persistent cough, the pathways are clear.

They are not so clear, however, for the patient who has made several visits to the surgery with systemic symptoms that do not fit neatly into a specific area of specialist medicine.

Public awareness

In 2013 the DH will be launching a new cancer public awareness campaign that focuses on generic cancer symptoms, not tumour sites.

I fully support this move - we need to improve early diagnosis of cancer right across the board and this kind of campaign will cast a wider cancer net that includes less common cancers, such as pancreatic cancer.

To support this, we must start to think how we can reinvigorate our communications with consultant colleagues should we face a clinical conundrum and need some advice on the next steps in the pathway.

Lots of good ideas were put forward at the Early Diagnosis Summit, by clinicians and patients, from simple hotlines to primary care for informal consultations, to more structured clinic arrangements for patients who fall between the specialist stools.

I hope that with the changes in the NHS and the drive being much more clinically focused, clinicians can work together and achieve success with our secondary care colleagues, such that when we see a patient with something that our sixth sense says is wrong, local agreement on who to speak to, or refer urgently to, can be easily established.

This would combine very neatly with a public awareness campaign and allow patients to be fast-tracked into a pathway.

  • Dr Watson is a GP principal, associate medical director, Pennine Care NHS Foundation Trust, Lancashire, and national clinical lead primary care, NHS improvement - cancer.

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