NICE Referral for Suspected Cancer Guideline

On Monday I travelled to Manchester for the first of what will be many meetings to discuss the update to the NICE Referral for Suspected Cancer Guideline for GPs. Pancreatic Cancer Action is a stakeholder in this process and Monday’s meeting was to discuss the scoping of the update.

One of the changes from the current guideline (last published in 2005) is that the new guideline is to be more symptoms based than previously. I can hear you all saying now that surely the current guideline is already symptoms based and why do we need the change? Well that is true to a certain extent but the current guideline was structured around cancer type rather than presenting signs and symptoms so the guideline user (the GP) had to first think cancer, then think site and finally compare the patient’s symptoms with the guideline.

A little back to front, especially for pancreatic cancer, when it is difficult to get clinicians to think of this cancer first off when making a diagnosis.  This goes some way to explain why general practitioners in the UK diagnose only 18 per cent of cases.

What also came out of Monday’s meeting is that there will be a focus on clusters of symptoms. This too is good news for pancreatic cancer, as symptoms of pancreatic cancer in isolation can, more often than not, be thought of as being related to benign disease. The late Dr Simon Cats, a London GP who diagnosed himself with pancreatic cancer in 2011 succinctly argued the point in an article to the Daily Express; “Every symptom was mild. You have a little bit of pain, a little bit of heartburn, a little bit of fullness, a little bit of nausea, a little discomfort – which is what I call my dressing-gown sign – and a little bit of backache. If you have three or four of these symptoms you should be checked.” He went on,  “…if you have these symptoms and they persist, you should have them investigated.”

This is all great but the current guideline does not include a diagnostic algorithm for pancreatic cancer and this is something that I will be pushing for. With pancreatic cancer, GPs need to act fast and they need to know when to refer, who to refer to and what investigative tests for pancreatic cancer need to be performed and when. I will be working with pancreatic cancer specialists up and down the UK along with the Pancreatic Society of Great Britain and Ireland to ensure that the right information is included in the new guideline.

This will mean a lot of travel and meetings. However, ensuring future patients are diagnosed earlier and in time for potentially curative surgery is fundamental to what Pancreatic Cancer Action is all about and it is so worth the investment of our time, effort and money.