Bowel Cancer: rising to the challenge of faster diagnosis
David l’Anson [pictured right], Cancer Improvement Manager at South East London Cancer Alliance and Mr Alexis Schizas [pictured left], Consultant Colorectal and General Surgeon, Guy’s and St Thomas’ NHS Foundation Trust, blog about the challenges surrounding bowel cancer diagnosis and how new telephone assessment clinics are helping to speed up care.
Cancer. The big C - a word we all hope never to hear from our doctor.
However, the latest statistics show that one in two people in the UK will be diagnosed with cancer in their lifetime. We have made great strides in the diagnosis and treatment of cancer in recent decades, with survival past ten years doubling in the UK in the last 40 years, but there is still a huge amount of work to be done.
We have known for a long time that the earlier cancer is diagnosed, the better the outcomes are for patients. This puts a tremendous amount of pressure on both primary and secondary care to catch the early signs of cancer, diagnose and begin treatment as quickly as possible.
The fourth most common cancer
Bowel cancer, also called colorectal cancer, is the fourth most common cancer in the UK with roughly 42,000 people diagnosed every year.
Bowel cancer can affect anyone of any age, but it is more common in older people with more than nine out of ten new cases (94%) diagnosed in people over the age of 50, and nearly six out of ten cases (59%) diagnosed in people aged 70 or over.
Bowel cancer can be difficult to diagnose as the most common symptoms are generally related to the functions of the bowel, which fluctuate daily, and so a change in bowel habit or diarrhoea for example, can be quite general. It is difficult to identify when these are a warning sign of something more sinister or if they are simply an isolated occurrence or another non-cancer-related problem.
For this reason, the overwhelming majority of referrals in south east London (96%) will turn out not to be cancer. Doctors must therefore weigh up if there is a reason to suspect cancer based on additional factors as well as the patient’s symptoms, such as age, diet, lifestyle and genetics. This is proving more of a challenge than ever as we are seeing younger patients with bowel cancer and so using age as the predominant risk factor is no longer as useful as it used to be.
Once a patient sees their GP and is referred for a suspected cancer there starts a prolonged period of extreme anxiety and worry. Not least surrounding whether they have cancer or not, but what tests they will have to undergo and what to expect over the coming weeks.
It is our duty to provide them with an answer as quickly as possible.
Speeding up diagnosis
One of biggest challenges in reducing the time to diagnosis is the wait for a diagnostic test (a test which helps identify if a person has a particular disease or condition).
In order to shorten this time as much as possible, the Colorectal Tumour Group within the South East London Cancer Alliance has been introducing Telephone Assessment Clinics (TAC) across the region. This new model of care means that upon referral by their GP, patients will receive a one on one phone call with a specialist nurse to discuss their symptoms and the patient’s past medical history in order to determine what diagnostic test would be most appropriate and answer any questions the patient might have.
This phone call replaces the need for a patient to travel into hospital for an outpatient appointment (saving them time and money) to then be referred for a test. The aim is to perform the TAC within three days of referral, and even on the same day in some cases. Whereas the wait for an outpatient appointment can be up to two weeks, thereby significantly reducing the delay to requesting a diagnostic test.
Telephone Assessment Clinics are now running at all sites across all three trusts in south east London and the implementation of the project is 28% ahead of its schedule. Key to the successful implementation of TAC has been the collaborative approach taken across the region. With shared learning and standardised approaches, we can ensure a high quality of care for our patients regardless of where they live.
The aim is to have Telephone Assessment Clinics fully embedded for all lower gastro intestinal suspected cancer referrals in South East London by April 2020, when the new faster diagnosis standard will begin, in which a diagnosis must be provided to the patient within 28 days of referral.
The Telephone Assessment Clinics offer a simple, yet innovative way of reducing the time spent waiting for a diagnostic test and ultimately a diagnosis or exclusion of cancer. Every day this saves is a day a person isn’t left with the worry of not knowing if they have cancer or not. Approaches like this, along with many others happening across the region, form a core part of the vision of the South East London Cancer Alliance together with King’s Health Partners to provide the best in cancer care for our patients.
As a European Comprehensive Cancer Centre, the King's Health Partners Cancer Clinical Academic Group brings together world-class clinical services, research and education for the benefit of cancer patients in south east London and beyond.
A very special thanks to all the nurses, consultants and managers across all trusts in south east London involved in implementing TAC, without whom it would not be possible and whose dedication and tireless efforts to provide the best possible care for our patients is second to none.
For further information, contact the Cancer Improvement Manager responsible for TAC, David I’Anson.