Incentivise GPs for cancer referral

GPs need better incentives to follow cancer referral guidelines, despite research showing that urgent referrals are failing to improve outcomes for lung cancer, say cancer experts.

For the study, referral methods and outcomes were examined for 889 UK patients diagnosed with lung, colorectal, prostate or ovarian cancer.

Among 409 patients with lung cancer, those diagnosed after urgent referral had a more advanced cancer stage at diagnosis than those diagnosed via other routes.

Analysis of survival data for 303 lung cancer patients also showed that those diagnosed through urgent referrals had shorter survival times. This was not the case for the other three cancers. But instead of rejecting urgent cancer referral guidelines, GPs should be extra vigilant for the symptoms of cancers said lead researcher and Cardiff GP Dr Richard Neal.

‘GPs are not using the referral guidelines properly. Some patients who fulfil referral guidelines aren’t being referred,’ he said.

Incentives to follow these guidelines could cut the time between patients developing symptoms and referral to secondary care, explained Dr Neal.

‘There’s no incentive at any point in the system of primary care to check who’s being referred and when they’re referred. There might be scope to see where this could be incorporated under the quality framework.’

Urgent referral guidelines target smokers, former smokers or people exposed to asbestos who have persistent haemoptysis, signs of superior vena cava obstruction, stridor and a chest X-ray suggestive of lung cancer.

But even a negative chest X-ray cannot rule out lung cancer and if GPs still suspect it, patients should be referred anyway or followed-up with repeat X-rays, said Dr Neal.

Dr Siow Ming Lee, a consultant medical oncologist at University College Hospital in London, said the finding was expected: ‘for lung cancer, pick up by GPs tends to be a lot worse. The more symptomatic the cancer, the more aggressive.’

Screening smokers for lung cancer has not yet been shown to improve outcomes.

The latest study from the US has shown that computed tomography screening of 3,246 asymptomatic current or asymptomatic smokers led to a three-fold more diagnoses.

But there was no evidence for a reduction in the number of advanced tumours diagnosed or death rates.

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