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Doctors should be encouraged to use ‘safety netting’ to improve cancer detection in patients with vague symptoms, say primary care researchers from Oxford University in The BMJ today.

© OUImages/Nasir Hamid

Safety netting ensures patients do not drop through the healthcare net but are monitored until symptoms are explained. This includes explaining uncertainty about the cause of symptoms and making sure patients receive test results even if they do not attend a follow-up appointment.

Patients visit their doctor every day about symptoms that could be cancer. Some will have easily recognised high risk symptoms such as difficulty swallowing (dysphagia) or coughing up blood (haemoptysis). But most will have vague or non-specific symptoms like cough, fatigue, or abdominal pain, where the likelihood of cancer is low.

Faced with this uncertainty, doctors have a responsibility to avoid causing unnecessary alarm and wasting scarce resources through over-investigation, which may result in harm to the patient. But this must be balanced with the potential harm of delaying a diagnosis of serious disease.

Safety netting is regarded as “best practice” for cancer diagnosis - allowing doctors to tease out serious disease by following up patients over time. But there is little evidence on whether it improves cancer detection and how best to do it in patients with vague symptoms.

So Dr Brian Nicholson and colleagues in Oxford University's Nuffield Department of Primary Care Health Sciences searched for evidence on how safety netting can be done effectively as part of a project funded by Cancer Research UK.

They found no apparent evidence on whether safety netting is effective. However, they did find evidence on three main issues: the necessary components of safety netting, the roles of patient and doctor, and the problems arising from miscommunication or misinterpretation of initial test results.

Based on this evidence, the authors recommend that doctors explain uncertainty about the cause of symptoms with patients, ensuring they understand why, when and with who they should re-consult about which concerning symptoms.

Systems should also be in place to ensure that test results are reviewed by somebody with knowledge of cancer guidelines, and that positive and negative results are communicated to the patient promptly.

"Although the evidence base is uncertain, safety netting remains the best option, and is likely better than nothing,” say the authors. “It is important that patients continue to visit their doctor until their symptoms are explained. We know that doctors are safety netting every day to keep their patients safe. By conducting research on safety netting we will be able to understand which safety netting messages and systems are effective.”

Read the paper:

Can safety netting improve cancer detection in patients with vague symptoms?
Nicholson B, Mant D, Bankhead C.
The BMJ 2016 DOI: 10.1136/bmj.i5515


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