Tools to support diagnosing cancer in primary care

Macmillan's cancer decision support tool and rapid referral toolkit can help GPs in cases when presenting symptoms are vague or there is an absence of 'red flags', writes Macmillan GP Dr Anthony Cunliffe.

GPs will see on average six-eight new cancer diagnoses each year (Photo: iStock)
GPs will see on average six-eight new cancer diagnoses each year (Photo: iStock)

Diagnosing cancer in primary care can be difficult. A GP with a 2,000 patient list will see approximately six-eight new cancer diagnoses a year but will see many patients with symptoms or signs that could represent cancer.1 With this in mind, we all need guidance and tools to help us consider cancer as a possible diagnosis when perhaps the presenting symptoms are vague or there is an absence of ‘red flag’ symptoms.

Through my interest in cancer in primary care and my role within Macmillan I was aware of the cancer decision support tools developed by Professors Willie Hamilton and Julia Hippisley-Cox and started to use the electronic version of these developed by Macmillan, the cancer decision support tool (eCDS).

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eCDS relies on the Read-coded symptom information in the patient’s record. It can detect these codes and combine them with patient demographic information to calculate a percentage risk score of the patient having an as yet undiagnosed cancer. The GP is then encouraged to use their medical decision making to decide what action is needed, taking into account the percentage risk score which is provided as a ‘pop-up’ box alert.

Risk score

The tool has been found to be useful for those patients presenting with multiple or vague symptoms which would not normally prompt a GP to consider cancer as a possible diagnosis, or in practices where the same patient may see multiple GPs with various independent non-red flag symptoms.

The tool detects all symptoms coded by any of the various doctors thereby highlighting the overall clinical picture, and will display a percentage risk score alert as soon as the patient’s notes are opened.

The GP can use the ‘symptom checker’ function to add additional symptoms perhaps not previously coded, to see if this affects the calculated score. The GP can then decide if further actions are needed, and use their medical decision making to determine if other illnesses may be causing the symptoms.

The tool can also support the decision to arrange investigations within or direct from primary care or check the symptoms with the NICE urgent suspected cancer (NG12) guidelines and, if appropriate, make a referral. 

Rapid referral guidance

I am also using Macmillan’s recently developed rapid referral guidance for suspected cancer for England and Wales to support my referral decisions. I’ve found it very useful when considering referrals or further investigations.

The tool is an interactive PDF based on the 2015 update of NG12 guidance which supports all recommendations in the guideline except those relating to specific childhood cancers. It is available for desktop, mobile and tablet devices and provides support, guidance and practical advice for GPs.

1. Rubin, Greg et al. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16(12): 1231-72.

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