Detecting Cancer earlier in Tower Hamlets The New Network ServiceDr. Tania AnastasiadisTower Hamlets GP Cancer Lead& GP Macmillan facilitatorThe Tools well need

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

A postcode lottery?The Sunday Times article relates to those diagnosed at Stage 1+2 (35.7%)

Half of London boroughs werent reported as there was not enough available data

We know residents in TH have more health inequalities & higher than average deprivation

Our rolePublic 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:

Patients being aware of symptoms that could mean cancerPatients deciding to presentGPs recognising symptoms Rapid referral of symptomatic patients for investigation and treatment

Training & updatingCommunity training and engagementReviewing and improving systems in primary careAuditing cancersIncreasing uptake of bowel screeningUse of cancer decision support tools Lung cancer targeting high risk groups

Training and updating teams in early diagnosis of cancer

Clinical & public facing non clinical eg PLTs, Talk Cancer, e-learning modules

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)

Auditing cancers

National audit of cancer diagnoses in primary care (2009/2010 NAEDI, RCGP)Same audit toolBetter understand and address the reasons for later diagnosis of cancer Identify local areas for improvement70 per auditFeature of future appraisals

Auditing Cancers part of annual appraisal..

Use of Clinical decision support tools (CDST)

90% patients diagnosed with cancer present with symptoms, most of these to primary careMany dont fulfill current urgent referral criteria(NICE updates are due..)Tools can help aid referral decisionsAID not REPLACE clinical judgement

Two different tools have been developed:

QcancerHamilton risk assessment tool

http://www.qcancer.org/

Primary Care Cancer Risk Assessment ToolNICE guidance implies risks above 3% require urgent referral. These tools help you to decide which patients below this level may benefit from urgent investigationTo be used to supplement NICE guidanceFor patients aged 40 and overTo calculate the risk value:For a single symptom, read the value from the top rowFor a single symptom presented more than once, read the value from the cell on the left hand diagonalFor multiple symptoms, read the value from the cell combining the worst 2 symptomsAmber and red risk values suggests 2WW referral; yellow and white may well be best managed by review within primary care, but use your discretionRisk assessment tool- mouse mat & easel

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 deathOthers improved mortality rates Lung unchanged..5 yr survival

Take home pointsMusculoskeletal 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 dont be falsely reassured

Screening for lung cancerUSA: 50,000 patients, 50% had a CT scan every 3 years20% fewer lung cancer deaths in the CT groupProven to reduce lung cancer deathsSmokers are a clearly defined cohort

Watch this spacePilots planned in UK to evaluate use further

European Age-Standardised Incidence Rates per 100,000 Population, by Sex, UKLung 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

*