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Cancer Update for Primary Care GPVTS Teaching

Cancer Update for Primary Care GPVTS Teaching. April 2017 Phil Sawyer HVCCG Macmillan Cancer Lead. content. Background Primary care role Prevention Screening Diagnosis Follow-up Survivorship (End of Life Care) Case reviews. Cancer – what is it?. Unregulated cell growth

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Cancer Update for Primary Care GPVTS Teaching

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  1. Cancer Update for Primary CareGPVTS Teaching April 2017 Phil Sawyer HVCCG Macmillan Cancer Lead

  2. content • Background • Primary care role • Prevention • Screening • Diagnosis • Follow-up • Survivorship • (End of Life Care) • Case reviews

  3. Cancer – what is it? • Unregulated cell growth • Symptoms and death result from local or distant spread and systemic effects • Can affect any organ, some more common • Multiple steps in development • Risk factors linked • Genetic factors • 1 in 2 will get a cancer, 1 in 3-4 cause of death

  4. Disease course variables • Tumour type (e.g. lung, pancreas, colorectal and breast) • Aggressiveness within type (e.g. prostate) • Location (e.g. head and neck tumours) • Stage and spread at diagnosis (Tumour, Nodes, Metastases) • Response to treatments (surgery, chemo, radioRx) • Patients’ co-morbidities and lifestyle

  5. Screening • Wilson criteria (weigh up pros & cons) • the condition should be an important health problem • the natural history of the condition should be understood • there should be a recognisable latent or early symptomatic stage • there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific • there should be an accepted treatment recognised for the disease • treatment should be more effective if started early • there should be a policy on who should be treated • diagnosis and treatment should be cost-effective • case-finding should be a continuous process

  6. Screening(2) • Breast (to prevent 1 death we must screen 235 women 3 yearly for 20 yrs) • Cervical. Less over-treatment since HPV testing. • Colorectal – faecal occult blood & scope (detects and removes premalignant polyps) • Flexisigmoidoscopy (age 55) • Prostate Risk Management programme controversial. To prevent 1 death we must screen 1055 men for 11 years. • If you choose not to have PSA test you can live similar length life, have little or no difference in dying from prostate cancer and avoid the not insignificant harms associated with tests, procedures and treatment

  7. GP – needles in haystacks • Sees <10 new cancers a year but many who are anxious about this possible diagnosis • Manages many acute & chronic conditions • Needs to be alert to ‘high risk’ signs/symptoms (knowledge of guidelines) • Needs to refer to right team with appropriate urgency (using right forms) • Safety-netting. Info for patient re process. • Expect <10% ‘conversion rate’

  8. NICE 2015 suspected cancer guidelines • changes since previous guidelines • Tumour sites Children Symptoms • useful resources • referral proformas (e-Ref/email nhs.net) • FOBs • direct access to diagnostics • info sheets (incl. ‘non-urgent’ breast) • lung CT pathway

  9. Suspected cancer guidelines • Based on research • PPV of 3% • More flexible. GP acumen respected. • Direct access to diagnostics • Symptoms may need investigating along more than one pathway initially • Time limits withdrawn • Raised platelets • Safety-netting and patient information

  10. resources • www.gp-update.co.uk/Latest-Updates/Our-concise-NICE-2015-Cancer-Summary • www.macmillan.org.uk/Documents/AboutUs/Health_professionals/PCCL/Rapidreferralguidelines.pdf • BMJ

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