Detecting Cancer earlier in Tower Hamlets – The New Network Service

1. Detecting Cancer earlier in Tower Hamlets – The New Network Service The Tools we’ll need Dr. Tania Anastasiadis Tower Hamlets GP Cancer Lead & GP Macmillan facilitator

2. Sunday times 11th May 2014

3. 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)

4. 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

5. 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

6. Reviewing and improving systems in primary care Use of cancer decision support tools Training & updating Community training and engagement Lung cancer – targeting high risk groups Auditing cancers Increasing uptake of bowel screening

7. Training and updating teams in early diagnosis of cancer • Clinical & public facing non clinical eg PLTs, Talk Cancer, e-learning modules http://cancerawarenesstoolkit.com/

8. Community organisation engagement • Increasing public awareness

9. 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) http://www.smallc.org.uk/health-professionals/resource-packs/

10. 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..

11. 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

12. Two different tools have been developed: Hamilton risk assessment tool Qcancer

13. http://www.qcancer.org/

14. Risk assessment tool- mouse mat & easel • 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: • For a single symptom, read the value from the top row • For a single symptom presented more than once, read the value from the cell on the left hand diagonal • 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

15. Macmillan Cancer Support- Early Diagnosis Programme (Links to papers / guides to both) CEG – Cancer risk assessment template Integration into Emis web – on the way…

16. Increasing uptake of bowel screening • Based on what we know from local pilots works

17. 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)

18. 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

19. 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

20. European Age-Standardised Incidence Rates per 100,000 Population, by Sex, UK Lung cancer Incidence Rates per 100,000 Population, by Sex, UK

22. This afternoon - GP, Secondary Care & Public Health Input - Finer brush strokes! - Macmillan resource packs for GPs - Screening resources