Changes to cancer pathways during pandemic 'could benefit patients long term'

Some of the changes in how hospitals are dealing with two-week cancer referrals could lead to longer-term improvement in care pathways, a leading expert has said.

Patients may not always require a colonoscopy (Photo: kzenon/Getty Images)
Patients may not always require a colonoscopy (Photo: kzenon/Getty Images)

Professor Willie Hamilton, professor of primary care diagnostics at the University of Exeter and the clinical lead on NICE's NG12 guideline on referral of suspected cancer, said the changes could potentially 'streamline pathways' for some patients.

Speaking in an online event on optimising cancer diagnosis during the pandemic, which was part of MIMS Learning Live Digital this week, Professor Hamilton stressed that GPs' role in diagnosing and referring suspected cancers in primary care hadn't changed as a result of COVID-19. However secondary care has 'made lots of changes to try and cope with dealing with two-week referrals in a different way', he said.

Suspected colorectal cancer

He cited suspected colorectal cancer as one area where these changes could be for the better. Some hospitals have introduced faecal immunochemical testing (FIT) for all patients who would have traditionally qualified for a two-week-wait referral, he explained.

Professor Hamilton said: 'What's very interesting is the next step will be that the diagnostic test has changed depending on what the faecal immunochemical testing result is. In someone who we normally send for colonoscopy, if [the FIT result is] in the middle range between 10 and 100, maybe we'll get a capsule endoscopy, rather than a colonoscopy - and the colonoscopies are being reserved for the really high FITs.'

He added: 'I'm perfectly in support of that. There's now quite good evidence emerging that this is pretty safe practice.'

Professor Hamilton said that when the pandemic subsides the NHS would have to 'readdress the situation and see is this actually better for our patients?'

'We may actually get some benefit, ultimately, from COVID in streamlining pathways for patients,' he said.

Blood test

Professor Hamilton also highlighted CA125 blood testing for ovarian cancer. 'We now have published evidence showing just how effective CA125 testing is in ruling out or ruling in the possibility of ovarian cancer,' he said.

'So while we were a bit doubtful about this until a few months ago, we now can feel much more comfortable in primary care that offering women this is safe, good medicine. And it's done in surgery, so patients don't have to feel worried that they're exposing themselves to risk by going to secondary care.'

Skin cancer referrals were another area where GPs were likely to have seen changes in how referrals worked, Professor Hamilton said. He suggested that 'photo dermatology' was likely to become much more widespread, with hospitals possibly requesting pictures to accompany referrals.

Also taking part in the webinar was east London GP and PCN clinical lead Dr Farzana Hussain. She said that GPs should not be 'afraid to refer into cancer lines because of the delay'.

Safety netting referrals

However, she added that practices in her PCN had found the cancer safety net template especially useful in tracking referrals.

She said using the template was 'good practice' and allowed GPs to 'put a calendar date' on all two-week-wait referrals so that admin teams could then check whether patients had been seen.

'Certainly locally, I am finding that they are not managing to, in every case, see people in that two weeks. So it's all the more reason that we do refer, and we bring that up because patients still need care and this falls under urgent care,' Dr Hussain added.

'My message to GPs would be, don't stop referring - and if you can monitor your referrals and see whether those patients are actually being given a date in two weeks, that will be useful. And feedback, if that's not happening.'

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