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Oxford-led international study suggests explanation for differences in international survival.

Features of the interface between primary and specialist care in the UK may constrain the readiness of GPs to refer patients and may be important in our poor cancer survival compared with other countries.
- Dr Peter Rose, Nuffield Department of Primary Care Health Sciences, University of Oxford.

GPs across England, Wales and Northern Ireland are less likely to immediately refer people with possible cancer for tests or to a specialist than those in comparable countries, according to new research published in BMJ Open.

The research shows a link between survival and those countries where GPs were more likely to refer patients immediately and those who did not. The UK based GPs were least likely to refer quickly.

UK cancer survival is lower than each of the other countries examined, except for Denmark.

The results from the International Cancer Benchmarking Partnership (ICBP) – a collaboration between six countries from around the world with similar health care systems – reveals striking new evidence for a possible explanation of international survival differences.

2,795 GPs were surveyed on how they would manage different scenarios of patients coming to them with possible cases of either lung, colorectal or ovarian cancer. The results were mapped against survival data for those countries.

GPs were then asked a series of questions including what access they had to specific tests, waiting times for tests and results, and whether they could speak to cancer specialists for advice.

More than 70 per cent of the GPs who responded from England, Wales and Northern Ireland reported direct access to blood tests, X-rays and ultrasound for possible cancer diagnosis – similar to the rest of the countries.

Australian GPs in Victoria reported the highest access – around 99 per cent – to all these tests.

However, only around one in five GPs in England reported having direct access to CT and MRI scans, while their peers in all other countries reported having at least twice the level of direct access to these tests.

GPs from across England, Wales and Northern Ireland also reported some of the longest waiting times for the results of CT, MIR and ultrasound scans.

England’s waiting time for ultrasound and CT scans was nearly five weeks, Wales was around seven weeks for both types of scan, and Northern Ireland was around seven to eight weeks. The best performing region was New South Wales with a total waiting time of around one and a half weeks.

As well as delivering better results for patients, cancers detected at earlier stages generally cost considerably less to treat.

Dr Peter Rose, lead author based at the University of Oxford’s Nuffield Department of Primary Care Health Sciences, said:

“These striking findings are the first to identify factors in primary care that could be contributing to international differences in cancer outcomes. In particular they suggest that features of the interface between primary and specialist care in the UK may constrain the readiness of GPs to refer patients and may be important in our poor cancer survival compared with other countries. Further research is required to identify which specific factors could affect referral readiness for patients with cancer symptoms.”

Sara Hoim, Cancer Research UK’s director of early diagnosis, said:

“This work adds important detail to the complex problem of why the UK’s cancer survival lags behind other comparable countries. GPs have a difficult job to do. They have to ensure those who need specialist tests get them, without overloading a health system that’s already strained. But their role as gatekeepers to further investigation and specialist care does need to be reviewed in the current context. If the UK system means that patients are not being referred for tests or GP’s able to get a specialist opinion as necessary, then this can contribute to cancers being diagnosed and treated at a later stage and we urgently need to address this.”

The ICBP is a unique and innovative global partnership of clinicians, academics and policymakers. In the UK it is funded by the Department of Health, The Northern Ireland Cancer Registry, the Public Health Agency, Norther Ireland, South Wales Cancer Network, Tenovus and the Welsh Government. The partnership is programmed managed by Cancer Research UK.

Read more:

Altmetric ScoreExplaining variation in cancer survival between eleven jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey
Rose, P. et al. BMJ Open. 2015.


Cancer Research UK blog – Could changes to primary care help improve cancer survival?


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