Draft Scope: Referral Guidelines for suspected cancer

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE

Draft Scope (version 1.1)

 

1   Guideline title:
 
Referral guidelines for suspected cancer.
   
1.1   Short title
   
Referral guidelines for suspected cancer.

 

2   Background
 
  The Institute's clinical guidelines will support the implementation of National Service Frameworks (NSFs) in those aspects of care where a Framework is to be published. The statements in each NSF reflect the evidence that was available at the time the Framework was prepared.
   
b
  The National Institute for Clinical Excellence ('NICE' or 'the Institute') has commissioned the National Collaborating Centre for Primary Care to develop referral guidelines for suspected cancer for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health and Welsh Assembly Government (see Appendix). The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.


3     Clinical need for the guideline
     
 
Cancer was responsible for a quarter of all deaths in England and Wales in 1997, and for over half of all deaths among women between 45 and 55 years of age (Swerdlow et al., 2001). The incidence of new cases of cancer increased by 12% in males and 28% in females between 1960 and 1997. For some cancers, mortality rates in the UK compare unfavourably with those in other countries.
   
b
  Delays of 3-6 months between the onset of symptoms and diagnosis are associated with worse survival rates in breast cancer (Richards et al., 1999). However, evidence about the influence of relatively short delays in other cancers is less clear. The initial symptoms of some cancers can be difficult to distinguish from the symptoms of other more common disorders (Crosland and Jones, 1995), and delays can occur between the first presentation and referral for suspected cancer. In a study of the time between presentation and treatment of six common cancers in general practice, the median number of days between presentation of the first symptom or sign and initiation of referral was 0 days for breast, 28 days for large bowel, 31 days for lung, 84 days for oesophageal, 20 days for prostate and 66 days for stomach cancer (Jones and Dudgeon, 1992)

 

  The guideline
     
 
The guideline development process is described in detail in three booklets that are available from the NICE website (see 'Further information'). The Guideline Development Process - Information for Stakeholders describes how organisations can become involved in the development of a guideline.
   
b
  This document is the scope. It defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider.
   
c
 
The areas that will be addressed by the guideline are described in the following sections.
   
4.1 
  Population
   
4.1.1
  Groups that will be covered
   
a
 

Patients in all age groups suspected of having one of the cancers covered by the guideline will be included.

   
b
 

The guideline will cover the following cancers:

  • lung
  • upper gastrointestinal cancers
  • lower gastrointestinal cancers
  • breast cancer
  • gynaecological cancers
  • urological cancers
  • haematological malignancies
  • skin cancers
  • head and neck cancers
  • brain tumours
  • sarcomas
  • children's tumours.
c
  The guideline will address the initial investigations that could form part of patient management prior to, or in association with, referral.
   
d
  The guideline will address the information needs of patients who are referred for suspected cancer.
   
e
  The guideline will address interventions intended to help healthcare professionals minimise delay in suspecting cancer.
   
4.1.2
  Groups that will not be covered
   
a
  The guideline will not cover the organisation or effectiveness of screening schemes for cancer.
   
b
  The guideline will not cover the tests undertaken after referral.
   
c
  The guideline will not cover referral for suspected recurrence or metastases in previously diagnosed cancer, or referral for palliative care.
   
4.2
  Healthcare setting
   
a
  The guideline will cover the care received from healthcare professionals who have direct contact with, and make decisions concerning, the referral of people with suspected cancer.
   
b
  The guideline will address care in primary care prior to referral for specialist assessment, but will not address care after referral in secondary and tertiary centres.
   
c
  The guideline will also be relevant to healthcare professionals in secondary care who suspect a patient they are managing for another condition also has cancer, and in whom referral to another specialist would be indicated.
   
d
 

The guideline will also be relevant to the work, but will not cover the practice, of those working in:

  • accident and emergency departments
  • walk-in centres
  • NHS Direct
  • voluntary sector
4.3
  Clinical management
   
a
  As the diagnosis of suspected cancer is usually undertaken in specialist care after referral, diagnosis will not be covered by the guideline.
 
b
  The guideline will address the need for urgent referral, and the consequences of delay in referral.
   
c
 

The monitoring of patients after referral but before the first specialist assessment will be considered in the guideline.

   
4.4
Audit support within guideline
  The guideline will include review criteria and advice.
   
4.5
  Status
   
4.5.1
  Scope
   
  This is version 1 (first draft) of the scope for consultation.
   
4.5.2
  Guideline
   
  The development of the guideline recommendations will begin in November 2002.


5  
Further information
     
   

Information on the guideline development process is provided in:

  • The Guideline Development Process - Information for the Public and the NHS
  • The Guideline Development Process - Information for Stakeholders
  • The Guideline Development Process - Information for National Collaborating Centres and Guideline Development Groups

These booklets are available as PDF files from the NICE website. Information of the progress of the guideline will also be available from the website.

 

References
   
 
  • Crosland A, Jones R (1995) Rectal bleeding: prevalence and consultation behaviour. British Medical Journal 311:486-8.
  • Jones RVH, Dudgeon TA (1992) Time between presentation and treatment of six common cancers: a study in Devon. The British Journal of General Practice 42:419-22.
  • Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ (1999) Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353:1119-26
  • Swerdlow A, Silva I dos S, Doll R (2001) Cancer Incidence and Mortality in England and Wales. Trends and Risk Factors. Oxford: Oxford University Press.
 
Appendix - Referral from the Department of Health and Welsh Assembly Government
   
The Department of Health and Welsh Assembly Government asked the Institute:

"To prepare referral guidelines for suspected cancer for the NHS in England and Wales by taking account of the guidelines published by the NHS Executive in April 2000 and the all Wales Minimum Standards for Cancer Services. The scope of the guidelines should include at least all those tumour types dealt with in those publications."

 

 

 

 

 

 

This page was last updated: 30 March 2010

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.