Prevention and early diagnosis
Approximately 42% of cancer cases each year in the UK are linked to a combination of lifestyle and other factors that are preventable. Smoking is the largest, single preventable cause of cancer each year in the UK, with excess body weight being the second.
Cancer is the biggest cause of premature and avoidable death in south east London.
Late diagnosis is a major challenge. More than half of patients with colorectal, lung, or ovarian cancers aren’t diagnosed until their cancers have progressed to stage 3 or 4.
We are looking at the local health needs of the whole south east London population to help us target people who are at highest risk of developing cancer. Working across all of the NHS organisations in the area we are addressing awareness to diagnosis using five key stages:
1. Increase awareness of cancer symptoms
We want to build on the work of the Be Clear on Cancer campaigns, raising public awareness of signs and/or symptoms of cancer and encouraging people to see their GP without delay. We will evaluate how we provide prevention to patients who are on the two-week wait pathways, but who don’t have cancer.
2. Improve screening uptake
We want to increase the number of people being screened for cancer, so that all areas of London meet the same performance. We are particularly focused on increasing screening for bowel cancer.
3. Improve diagnostics in primary care
We aim to improve the ability of local GPs to detect cancer at the earliest possible stage. To support this, we are implementing the NICE cancer urgent referral guidance, consistent use of decision tools and better processes to reduce the chance of missing a cancer diagnosis.
4. Improve the patient journey from primary to secondary care
The interface between primary care (GP surgeries) and secondary care (hospitals) can sometimes lead to delays in care and confusion for patients. We are implementing a range of initiatives to improve diagnostics and the patient experience, including:
- Direct access to diagnosis, initially prioritising suspected lung cancers.
- A pilot Multi-disciplinary Diagnostic Clinic (MDC) at Guy’s Hospital for GPs to fast track patients for thorough checks if cancer is suspected but their symptoms require further investigation before referral to a specialist. The pilot will be evaluated for its impact and could be implemented at other hospitals to achieve more timely diagnoses for patients with serious, non-specific symptoms.
- Implementing a 24-hour acute oncology service phone line for south east London. This will direct patients, carers and GPs to an appropriate service for urgent advice and support.
5. Ensuring services meet 62-day waiting times
It is important for patients that we consistently meet the 62-day waiting time – treatment for cancer should always start within 62 days of an urgent referral with suspicion of cancer.
We do not have consistent approaches for certain groups of patients, including those who are diagnosed in A&E. This leads to delayed diagnosis and poor patient experience.
More standardised approaches and protocols across hospital sites, improving access to specialist imaging, and improving staffing could help us to make sure we always meet the 62-day standard.
Our priorities are:
- Ensuring that there is adequate diagnostic capacity and systems available
- Making sure our approach to diagnostics across south east London meets best practice, including the introduction of ‘straight to test pathways’ which can reduce the time to diagnosis and treatment for patients
- Improving diagnostic reporting and follow-up. This work will improve the process we follow for patients with incidental findings and those who require a consultant upgrade or who are diagnosed as an emergency