Cancer Audit Stourport Health Centre Feb 2016 Roy Williams

Background CCG funded audit of cancer diagnosis Aug 2014 to Feb 2015 61 cases Retrospective audit exploring primary care management leading to diagnosis

Cases 61 cancer diagnoses Breast 20 Lung 8 Colorectal 8 Upper GI 3 Melanoma 2 Prostate 3 Bladder 2 Haematological 3 Pancreas 2 Other 10

Breast Cancer 20 cases 12 screen detected (excluded) 8 Gp referred All 2 weeks wait all but 1 referred on 1st presentation Referral 0.8 days delay Diagnosis 19.3 days delay

Lung Cancer 8 cases 2 incidental when admitted for another problem 6 GP referred All 2 weeks wait 1.6 visits (1-4) Referral ave 43 days delay Diagnosis ave 32 days delay

Lung Cancer Learning point – consider CT scan if abnormal chest Xray – waiting for repeat chest Xray generates delay – especially if concerning symptoms ?Feedback to radiology re delays in diagnosis as a result of policy to repeat CXR in 4-6 weeks

Bladder Cancer 2 cases Both 2 weeks wait 2.5 visits – but according to guidelines Referral 35 days delay Diagnosis 100 days delay

Haematological Malignancy 4 cases 2 already under haematology follow up (excluded) 2 Gp referred One 2 weeks wait to colorectal, one private referral to haematology 2 visits before referral Referral 40 days delay Diagnosis 250 days delay

Pancreatic Cancer 2 cases 3 visits before diagnosis One declined referral Referral 37 days delay Diagnosis 240 days delay

Pancreatic Cancer Learning Point Consider CT abdo in patients with abnormal liver function tests – even if Ultrasound scan normal

Colorectal Cancer 8 cases 1 incidental, 1 screen detected (excluded) 6 Gp referred 3 - 2 weeks wait, 1 private, 2 routine (no red flag features 1.6 visits average before referral Referral 8 days delay Diagnosis 140 days delay

Colorectal Cancer Learning points Perhaps quicker if 2ww rather than private ?Falsely reassured by normal colonoscopy previous year Anaemia – patients without lower GI symptoms having upper GI scope ?should have both

Upper GI Cancer 3 cases 3 Gp referred All 2 weeks wait All referred on 1st presentation Referral 0 days delay Diagnosis 14 days delay

Prostate Cancer 3 cases 3 Gp referred All 2 weeks wait All referred on second presentation – bloods first Referral 13 days delay Diagnosis 252 days delay

Other Cancers Tongue x1 – 2/52 referral Melanoma x2 – one under follow up, one 2/52 Renal x1 – emergency presentation – no gp contact Penile x1 – routine – found incidentally at circumcision Thyroid – referred after scan

Unknown Primary 5 GP visits – delay 52 days Referred 2/52 CT scan but admitted before diagnosis Learning point – consider CT early if atypical symptoms

Summary Good results! Patients seen average 1.5 visits (range 1-5) Average time to referral 16 days Average time from referral to diagnosis 57 days Emergency presentations 1 unclear history – no red flags and had been referred 1 no recent GP contact 2 routine admissions – cancer incidental

Questions? ????