Our response to the updated guidelines for Suspected cancer: recognition and referral.

Today the National Institute for Health and Care Excellence (NICE) has issued updated guidelines for Suspected cancer: recognition and referral.

The news hit the headlines today with many of the news items in the newspapers and on television featuring a pancreatic cancer case study.  Interestingly, while the guidelines will help speed up the diagnosis of cancer generally, they are not as favourable as we would like for speeding up the diagnosis of pancreatic cancer patients.

Some of the positive updates to the current guidelines are that pancreatic cancer is now a disease subjection on its own rather than being lumped in as part of “Upper Gastrointestinal” cancers.    It’s also good to see the introduction of “new onset diabetes” as an additional symptom for consideration, something we have been educating GPs about in our educational programmes for the past 3 years.

It is also great that GPs will have more direct access to diagnostic tests that have traditionally needed a referral to specialists.  This should mean more patients with cancer will receive their diagnosis much earlier.

However, it’s disappointing that our views on the draft guidance during the consultation period were not taken into consideration and the referral guidelines are still focused on patients over the age of 60.  That age threshold is far too high and this could mean a lot of younger patients could be missed.  At the moment, the only guidelines for patients over 40 is that patients are referred for an urgent cancer pathway referral if they present jaundice.

We want to see the age to come down to at least 45 for all the symptoms recommended for referring people aged over 60.

We’re also disappointed to see weight loss is still being seen as the main symptom to prompt a referral even though it only counts as symptom in around 10% of pancreatic cancer diagnoses.  Epi-gastric pain and jaundice are far more common in patients and should be seen as a red flag symptoms by GPs.

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.  While the guidelines will hopefully speed up diagnosis for some patients, it is unlikely to have the dramatic impact on late diagnosis of pancreatic cancer that is desperately needed. This is why continuing to educate GPs on the signs and symptoms is absolutely vital.  In a few weeks, we will be visiting a GP surgery that, as a result of taking our GP elearning tool “Diagnosing Pancreatic Cancer in Primary Care”, is fast-tracking patients with new onset diabetes not associated with a metabolic condition to be tested for pancreatic cancer.  You can help us by taking our leaflets and flyers to your surgery about our e-learning programme as well as pancreatic cancer symptoms posters and fact sheets .  You can order them free of charge by sending an e-mail to Lisl at enquiries@panact.org.