Significant Event Analysis of Lung and Colorectal Cancer in Hull

Daniel Jones

PhD

The Practices

Bowel Cancer

Demographics

• 74 cases

• The age ranged from 36 to 96 years old

• The mean age was 71.36

• At the time of completing the SEAs, 58 (78%) patients were still alive with 16 deceased. Of the patients who died only 4 (25%) lived longer than a year after diagnosis, with 5 patients (28%) living less than three months after diagnosis.

Presenting symptoms

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A pie chart showing the referrals of patients diagnosed with bowel cancer

2ww colorectal

Urgent colorectal

Routine colorectal

Private

2ww upper GI

Emergency admission

2ww gynaecology

Lung cancer

Demographics

• 118 cases

• The age ranged from 45 to 95 years old

• The mean age was 71.30

• At the time of completing the SEAs, 54 (46%) patients were still alive.

• Only 5 (8%) lived longer than a year after diagnosis, with 28 patients (46%) living less than three months after diagnosis.

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Type of referral

• 81 (69%) patients were referred using the 2ww suspected lung cancer referral pathway.

• 24 (20%) of patients were diagnosed following an emergency admission.

• Four patients were referred routinely to the lung specialists,

• Other patients were sent on a 2ww referrals to upper GI, breast, colorectal and brain.

• One patient was not referred and was treated palliatively in primary care.

A smoker with a persistent cough was sent for a CXR which showed consolidation suggesting infection. The CXR report suggested treating with antibiotics and repeating the CXR in four to six weeks. However the patient was not seen for two weeks following the CXR, leading to delay in starting antibiotics and delay in repeating the CXR.

A current smoker presented on four occasions with new chest pain, this was thought to be muscular and was treated with physiotherapy, analgesia and reassurance on three occasions before a CXR was organised

• 37 (31%) patients had a CXR which was negative for lung cancer.

• A negative CXR significantly increased median time to diagnosis with a fivefold increase in time to referral.

• A detailed review of cases showed that negative CXRs seemed to divert the GPs attention away from the possibility of lung cancer with multiple trials of treatments, routine referrals and referrals to other specialities being made.

A patient with three months of altered bowel habit was advised to have bloods and then ‘review for scope’ the patient had bloods three days later showing IDA and marked to discuss however the patient is not seen following this for two months regarding the bowels, despite one telephone consult regarding cataracts.

In one case, anaemia was an incidental finding on routine blood tests, the result was marked as needing a repeat test but no further action was taken. It was not clear from the notes what had gone wrong in this case but a significant delay in diagnosis occurred as a result.