GP cancer diagnosis is delayed in a third of patients from minority ethnicities

A third of patients from Mixed, Black or Asian ethnicity backgrounds require three or more interactions with a GP before a cancer diagnosis, new analysis shows.

The analysis from QualityWatch, a joint programme from the Nuffield Trust and the Health Foundation, of available NHS cancer diagnosis data found that the number of visits to a GP surgery needed ahead of a cancer diagnosis varies depending on a person’s age, ethnicity, and socioeconomic status.

On average across the whole population one in five people had three or more GP interactions before being diagnosed. This increased to one in three for patients from minority ethnicities.

In addition, for 16–24-year-olds, one in every two required three or more interactions with a healthcare professional from a GP practice before being diagnosed and for 20% of this group, five or more interactions were required.

Nuffield Trust Senior Fellow Dr Liz Fisher said: “Delays to a cancer diagnosis pose real risks for people and an early diagnosis plays a pivotal role in determining the treatments available to people and determining outcomes. Detecting cancer early is vital to improving survival rates, for example, the rate of survival for bowel cancer drops significantly from 80% if caught in stage 2 to 11% at stage four.

“The NHS has set an ambitious goal to dramatically increase early detection of cancer, but performance in this area has stubbornly stalled in recent years. Everyone’s experience of cancer diagnosis is different but the risks to delays aren’t felt equally, with younger people and those from minority ethnic groups requiring more visits to health professionals to secure a diagnosis. Screening programmes have helped for some cancers, but more needs to be done to target support to specific groups given demand on cancer services is only set to grow.”

Diagnosing cancer at earlier stages has flatlined in recent years

According to the analysis, people from the most deprived populations in England are 21% less likely to be referred for urgent suspected cancer than those from areas with low levels of deprivation.

The report also highlighted concerns about the quality of communication received following a diagnosis of cancer. For example, across the population, one in four people said that when they were first told they had cancer it wasn’t explained in a way that they fully understood.

As efforts to diagnose cancer at earlier stages has flatlined in recent years and only 60% of cancer diagnoses are taking place before the cancer has progressed, the researchers said the report should give policymakers pause for thought. The NHS currently looks set to miss its own target to have 75% of cancers diagnosed at an early stage by 2028.

While the circumstances of each cancer diagnosis will vary, and depend partly on the type of cancer, a mismatch between investment and the demand pressure on cancer diagnostic services and access to general practice remain a barrier to the NHS’s ambition for faster cancer diagnosis.

Researchers also cautioned that screening alone isn’t the answer to improving the rates of early diagnosis, with the risk vs benefit ratio varying by cancer type and highly dependent on the patients who come forward.

GP practices in areas of high deprivation have a higher workload

The Royal College of GPs responded to the report and said that ensuring patients receive timely and appropriate referrals for suspected cancers is a priority for GPs – and to this end, they are doing a good job, making more urgent referrals and ensuring more cancers are being diagnosed at an early stage than ever.

Chair Professor Kamila Hawthorne added: “Whilst GPs are highly-trained to identify cancers, this remains challenging in primary care, not least and particularly with some cancers, because the symptoms are often vague and typical of other, more common conditions. This will particularly be the case in young people, as the risk of cancer will be much smaller, which goes someway to explaining this element of this research. But it also makes clear that health inequalities, and impact of them, extend to cancer diagnosis – and this must be addressed.

“First, we want to see better access for GPs to diagnostics right across the country, which will further inform our decision to refer, and help us to do so appropriately.

“Second, we know that practices in areas of high deprivation have a higher workload, more acute workforce pressures and less funding than those in less deprived areas, so we want to see more resources and targeted initiatives for these areas to enable them to provide patient care. Our general election manifesto outlines ways to do this, including more investment into recruitment and retention schemes and cuts to unnecessary bureaucracy – this will not only make it easier for patients to access GP care, but it will allow GPs to spend more time with their patients, and have the conversations necessary to consider less likely diagnoses.”