1. Cancer Audit Stourport Health Centre Feb 2016
Roy Williams

2. Background CCG funded audit of cancer diagnosis Aug 2014 to Feb 2015
61 cases
Retrospective audit exploring primary care management leading to diagnosis

3. Cases 61 cancer diagnoses Breast 20 Lung 8 Colorectal 8 Upper GI 3
Melanoma 2
Prostate 3
Bladder 2
Haematological 3
Pancreas 2
Other 10

4. Breast Cancer 20 cases 12 screen detected (excluded) 8 Gp referred
All 2 weeks wait
all but 1 referred on 1st presentation
Referral 0.8 days delay
Diagnosis 19.3 days delay

5. Lung Cancer 8 cases 2 incidental when admitted for another problem
6 GP referred
All 2 weeks wait
1.6 visits (1-4)
Referral ave 43 days delay
Diagnosis ave 32 days delay

6. Lung Cancer
Learning point – consider CT scan if abnormal chest Xray – waiting for repeat chest Xray generates delay – especially if concerning symptoms
?Feedback to radiology re delays in diagnosis as a result of policy to repeat CXR in 4-6 weeks

7. Bladder Cancer 2 cases Both 2 weeks wait
2.5 visits – but according to guidelines
Referral 35 days delay
Diagnosis 100 days delay

8. Haematological Malignancy
4 cases
2 already under haematology follow up (excluded)
2 Gp referred
One 2 weeks wait to colorectal, one private referral to haematology
2 visits before referral
Referral 40 days delay
Diagnosis 250 days delay

9. Pancreatic Cancer 2 cases 3 visits before diagnosis
One declined referral
Referral 37 days delay
Diagnosis 240 days delay

10. Pancreatic Cancer Learning Point
Consider CT abdo in patients with abnormal liver function tests – even if Ultrasound scan normal

11. Colorectal Cancer 8 cases 1 incidental, 1 screen detected (excluded)
6 Gp referred
3 - 2 weeks wait, 1 private, 2 routine (no red flag features
1.6 visits average before referral
Referral 8 days delay
Diagnosis 140 days delay

12. Colorectal Cancer Learning points
Perhaps quicker if 2ww rather than private
?Falsely reassured by normal colonoscopy previous year
Anaemia – patients without lower GI symptoms having upper GI scope ?should have both

13. Upper GI Cancer 3 cases 3 Gp referred All 2 weeks wait
All referred on 1st presentation
Referral 0 days delay
Diagnosis 14 days delay

14. Prostate Cancer 3 cases 3 Gp referred All 2 weeks wait
All referred on second presentation – bloods first
Referral 13 days delay
Diagnosis 252 days delay

15. Other Cancers Tongue x1 – 2/52 referral
Melanoma x2 – one under follow up, one 2/52
Renal x1 – emergency presentation – no gp contact
Penile x1 – routine – found incidentally at circumcision
Thyroid – referred after scan

16. Unknown Primary 5 GP visits – delay 52 days
Referred 2/52 CT scan but admitted before diagnosis
Learning point – consider CT early if atypical symptoms

17. Summary Good results! Patients seen average 1.5 visits (range 1-5)
Average time to referral 16 days
Average time from referral to diagnosis 57 days
Emergency presentations
1 unclear history – no red flags and had been referred
1 no recent GP contact
2 routine admissions – cancer incidental

18. Questions?
????