Doctors call for urgent review of UK cancer initiative

Oct 26 2005

Hospital doctors are calling for an urgent review of the UK Government’s two-week cancer wait, saying there’s no evidence that the initiative has had any impact on survival rates.

Serious concerns about the low number of malignancies diagnosed under the initiative have been expressed in the November issue of International Journal of Clinical Practice by a hospital research team and a leading cancer Professor.

The target, which was introduced in 2000, says that any patients with suspected cancer should be seen by a hospital specialist within two weeks of being referred to their GP.

“It’s not surprising that the two-week wait hasn’t had an impact on survival because the delay between the referral from primary care and the first specialist appointment is only a small part of the cancer pathway” says lead author Mr Stephen Hanna, who carried out his research with colleagues at Northampton General Hospital.

“The only effective way to diagnose and treat cancer earlier is to target all stages of the process, including patient education, screening, investigations and treatment.”

Mr Hanna and his colleagues have urged the Government to rethink their cancer target after they reviewed the results of 35 UK cancer studies carried out since the introduction of the target.

“Although some authors have reported improvements in waiting times for both the first appointment, and in some cases treatment, many studies have raised the common concern that the majority of malignancies are being detected outside the new system” adds Mr Hanna, now a specialist registrar at Leeds General Infirmary.

“Increased waiting times for other appointments have also been noted and this has raised fears that the target may actually be leading to a delay in diagnosing cancers in many patients.”

However, the authors do acknowledge that being seen promptly has an important psychological effect on worried patients.

Their review has been welcomed by Ian Fentiman, Professor of Surgical Oncology, who asks whether the target is a “milestone or a millstone”.

In his editorial on the review, published in the same issue, he says that only 40 per cent of confirmed breast cancer cases are referred to his unit under the two-week rule.

“Creating a two-tier system will only be acceptable if the majority of cancers are diagnosed in the urgent referral group” says Professor Fentiman.

“For example, only five per cent of breast cancers are diagnosed in women under 35, yet this age group forms the majority of referrals to one-stop breast clinics.”

Professor Fentiman says that overworked GPs often have to make difficult decisions within a 10-minute consultation and many tend to err on the side of caution. He says that they need better support to make decisions and suggests that the development of computer-aided diagnosis systems may be one possible solution.

“At an organisation level it would be better if the two-week rule was scrapped and all symptomatic patients seen within this time” he adds.

“Education, screening and re-organisation are the keys to improving survival for cancer patients. But at present resources are consumed in the monitoring of a discredited two-week rule which has had the reverse effect of what was intended.

“Where has all the cancer money gone? Not to the front line clinics. If we are serious about reducing cancer mortality then serious resources need to be deployed and deployed immediately.”