Detecting Cancer earlier in Tower Hamlets – The New Network Service Dr. Tania Anastasiadis Tower Hamlets GP Cancer Lead & GP Macmillan facilitator The Tools we’ll 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 <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: 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 Community training and engagement Reviewing and improving systems in primary care Auditing cancers Increasing uptake of bowel screening Use 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 tool Better understand and address the reasons for later diagnosis of cancer Identify local areas for improvement £70 per audit Feature 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 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: Qcancer Hamilton risk assessment tool

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 Risk 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 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

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