The Lancet Oncology recently reported on analysis of the findings from the 2010 National Cancer Patient Experience Survey. The authors identified variation in numbers of pre-referral consultations with general practitioners between patients with different cancers and patients with socio-demographic characteristics.
It reported that 7.4% of breast cancer patients, 10.1% of melanoma patients, 41.3% of pancreatic cancer patients and 50.6% of multiple myeloma patients visited their GP three or more times before referral. The obvious observation from these statistics is that cancers such as pancreatic cancer and multiple myeloma commonly take several consultations before the GP becomes sufficiently worried to refer. This is likely to be because such cancers often present in the early stages with non-specific symptoms such as pain, fatigue and weight loss which are symptoms also seen in many other non-cancerous conditions.
It is perhaps understandable that those cancers which present with non-specific or few symptoms are late in being diagnosed; however both breast cancer and melanoma commonly present with very specific symptoms which are easily observed by the lay patient e.g. a breast lump or changes in the size, shape or colour of a mole. Whilst the percentages of patients requiring three or more appointments before referral are much lower for these cancers, I think that these statistics more so than the higher percentages for pancreatic cancer and myeloma, exhibit a worrying trend; breast cancer and melanoma are cancers with very specific observable symptoms which have correspondingly detailed referral guidelines. Where a patient subsequently diagnosed with breast cancer or melanoma has presented to the GP on three occasions complaining of breast changes or changes in a mole, I would give serious consideration to whether there had been a negligent delay in referring for investigations.
Patients often do not want to question the advice they have received as they trust their GP and, completely understandably, they want to believe that their worrying symptom is nothing to worry about after all. So, where a patient is reassured about their symptoms by a doctor or nurse, there can be reluctance on the part of the patient to re-attend with the same complaint and this can lead to a long delay in going back to the surgery; where a further attendance is required, such delays can be compounded.
Medical negligence leading to delays in being referred for further investigations can have consequent delays on diagnosis and treatment and long delays may mean that the cancer is more advanced as a result, perhaps having spread to the lymph nodes or neighbouring organs. This can mean that a patient requires more radical surgery and adjunct therapies such as chemotherapy which may not have been necessary with earlier diagnosis. Patients may also have a poorer prognosis as a result of delays in receiving treatment.