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Improving Outcomes: A Strategy for Cancer, published in January 2011, committed over £450 million over the four years up to 2014-15 to achieve earlier diagnosis of symptomatic cancer. The earlier diagnosis money is designed to support centrally led Be Clear on Cancer (BCOC) campaigns; improved direct general practitioner (GP) access to four key diagnostic tests to support the diagnosis of brain tumours, bowel, lung, and ovarian cancers; and increased testing and treatment costs in secondary care. GPs are able to access these tests directly in cases where the two-week urgent referral pathway is not appropriate but a patient’s symptoms require further investigation. The intention is that more people presenting with relevant symptoms, including patients aged over 75 will be tested and at an earlier stage. NHS England monitors the use of these diagnostic tests through the Diagnostic Imaging Dataset.
Since 2011 the Department and Public Health England (since 2013) in partnership with NHS England (including NHS Improving Quality) and other stakeholders have run national BCOC campaigns for bladder and kidney, bowel, breast and lung cancers; regional campaigns for ovarian, oesophagogastric cancers, and local pilot campaigns to raise awareness of four symptoms of unexplained bleeding, lump, pain, and weight loss; and awareness of skin and prostate cancers.
BCOC campaigns are aimed at men and women over the age of 55 and their key influencers (e.g. family members) and use television (at regional and national level), radio and press and face-to-face events. The breast cancer campaign from February to March 2014 was specifically aimed at women over 70 as there is considerable evidence that many older women are not aware that they are still at risk.
In 2012, to increase the awareness of cancer amongst GPs and support GPs to assess all patients more effectively, the Department funded the British Medical Journal (BMJ) Learning to provide an e-learning tool for GPs. The modules include tackling late diagnosis; risk assessment tools; and cancer pathway and the role of primary care.
In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support tool for GPs to use in their routine practice. Following the pilot, Macmillan is now offering the tool free of charge to all GPs in the United Kingdom.
The National Institute for Health and Care Excellence (NICE) is in the process of updating the Referral Guidelines for Suspected Cancer (2005) to ensure that it reflects latest evidence and can continue to support GPs to identify patients with the symptoms of suspected cancer and urgently refer them as appropriate. NICE’s draft is currently out for consultation until 9 January 2015. The anticipated publication date for the revised guidelines is May 2015.
Men and women aged 75 and over are able to self-refer for bowel screening every two years if they wish. Women over 70 are able to self-refer every three years for breast screening.
Finally, NHS England in their recent publication ‘Five Year Forward View’ (October 2014) acknowledge that cancer survival is below the European average, especially for people aged over 75. The report highlights that improvements in outcomes will require action on better prevention; swifter access to diagnosis, and better treatment and care for all those diagnosed with cancer.