Detecting Cancer earlier in Tower
Hamlets – The New Network Service
The Tools we’ll need
Dr. Tania Anastasiadis
Tower Hamlets GP Cancer Lead
& GP Macmillan facilitator
Sunday times 11th May 2014
Our stats….
• TH mortality rates are amongst the highest in
the country and our survival rates amongst
the lowest
• Of 550 TH residents diagnosed with Cancer
<64% (350) were alive at 12 months post
diagnosis (Office of National Statistics 2010)
A postcode lottery…?
• The Sunday Times article relates to those
diagnosed at Stage 1+2 (35.7%)
• Half of London boroughs weren’t reported
as there was not enough available data…
• We know residents in TH have more health
inequalities & higher than average
deprivation
Our role…
• Public Health are funding the new NIS (£130,000)
• The outcome measures are based on current available evidence &
research to date
Early detection in primary care relies on:
•
•
•
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Patients being aware of symptoms that could mean cancer
Patients deciding to present
GPs recognising symptoms
Rapid referral of symptomatic patients for investigation and
treatment
Training &
updating
Reviewing and
improving
systems in
primary care
Use of cancer
decision support
tools
Community
training and
engagement
Auditing
cancers
Lung cancer –
targeting high risk
groups
Increasing
uptake of bowel
screening
Training and updating teams in early
diagnosis of cancer
• Clinical & public facing non clinical
eg PLTs, Talk Cancer, e-learning modules
http://cancerawarenesstoolkit.com/
Community organisation engagement
• Increasing public awareness
Reviewing and improving systems in
primary care
• SEA/peer discussion relating to
newly diagnosed cancers
• Strengthened safety netting eg
‘small-c’ resource packs
• Meeting with CCG Cancer Lead
(practice profiles, bowel screening
metrics, cancer audits, identify
barriers to earlier diagnosis)
http://www.smallc.org.uk/health-professionals/resource-packs/
Auditing cancers
• National audit of cancer diagnoses in primary care
(2009/2010 NAEDI, RCGP)
• Same audit tool
• Better understand and address the reasons for later diagnosis
of cancer
• Identify local areas for improvement
• £70 per audit
• Feature of future appraisals…
Use of Clinical decision support
tools (CDST)
• 90% patients diagnosed with cancer present with
symptoms, most of these to primary care
• Many don’t fulfill current urgent referral
criteria…(NICE updates are due..)
• Tools can help aid referral decisions
• AID not REPLACE clinical judgement
• Two different tools have been developed:
Hamilton risk
assessment tool
Qcancer
http://www.qcancer.org/
Risk assessment tool- mouse mat & easel
Primary Care Cancer Risk Assessment Tool
NICE guidance implies risks above 3% require urgent referral. These tools help you
to decide which patients below this level may benefit from urgent investigation
 To be used to supplement NICE guidance
 For patients aged 40 and over
 To calculate the risk value:
o For a single symptom, read the value from the top row
o For a single symptom presented more than once, read the value from
the cell on the left hand diagonal
o For multiple symptoms, read the value from the cell combining the
worst 2 symptoms
 Amber and red risk values suggests 2WW referral; yellow and white may well
be best managed by review within primary care, but use your discretion
Macmillan Cancer Support- Early Diagnosis
Programme
(Links to papers / guides to both)
CEG – Cancer risk assessment template
Integration into Emis web – on the way…
Increasing uptake of bowel screening
• Based on what we know from local pilots
works
Lung Cancer - targeting the high
risk groups
• Leading cause of cancer death
• Others improved mortality rates
Lung unchanged..
• 5 yr survival <10% locally (CRC 50.2%)
• Present LATE (80% stage III&IV)
Take home points
• Musculoskeletal sounding pain (neck or shoulder) can be a presenting
symptom have a low threshold for CXR
• Heightened suspicion of lung cancer in patients with worsening COPD or
new or persistent COPD symptoms
• NICE guidance : newly diagnosed COPD need CXRs
(NIS outcome measure)
Lung cancer cannot be excluded even if a CXR is normal
REFER IF SUSPECT
don’t be falsely reassured
Screening for lung cancer…
• USA: 50,000 patients, 50% had a CT scan every
3 years
• 20% fewer lung cancer deaths in the CT group
• Proven to reduce lung cancer deaths
• Smokers are a clearly defined cohort
Watch this space…Pilots planned in UK to
evaluate use further
Lung cancer Incidence Rates
per 100,000 Population, by Sex, UK
This afternoon
- GP, Secondary Care & Public Health Input
- Finer brush strokes!
- Macmillan resource packs for GPs
- Screening resources