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Summary of Results

Health Topic:   Cancer
Guidance:   Referral for suspected cancer
Description:   The summary of the published clinical guideline on Referral for suspected cancer. It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

Bakhai M et al (2010) A retrospective study comparing the accuracy of prehistology diagnosis and surgical excision of malignant melanomas by general practitioners and hospital specialists Clinical and Experimental Dermatology 35(1):63-7

Description: A retrospective study was carried out to compare the overall standard of surgical excision of malignant melanomas (MMs) between GP's and hospital specialists pre and post-introduction of NICE guidelines. Since the introduction of guidelines GP's showed a significant improvement in the completeness of melanoma excision but remained poor at prehistology diagnosis. Implementation of guidelines has not produced significant improvements in adequacy of excision margins in primary and secondary care.

Not graded Regional

Ballal M.S et al (2009) Use of a patient consultation questionnaire and weighted numerical scoring system for the prediction of colorectal cancer and other colorectal pathology in symptomatic patients: A prospective cohort validation study of a Welsh population Colorectal Disease 12, 407-415

Description: The authors conducted a prospective study of symptomatic patients referred by primary care to the colorecal service in a district general hospital. A definitive diagnosis was established in 3457 patients. 186 (5.4%) had colorectal cancer. Compliance by primary care with NICE referral guidelines for suspected cancer was found to be 58%

Doubts about or mixed impact in practice Local

Mak, T et al (2010) The Impact of NICE guidelines on the diagnosis of colorectal cancer from patients with iron deficiency anaemia Colorectal Disease 12 (Suppl. 1) 15-47

Description: Data from a hospital laboratory, the cancer registry and The Health Improvement Network (THIN) GP databasewere analysed. Between January 2000-December 2006, 628,882 patients were identified. A total of 578 patients with iron deficiency anaemia (IDA) were identified who were subsequently found to have colorectal cancer. Statistical analysis demonstrated no difference in the time to diagnosis for colorectal cancer following IDA in the period before and after the publication of NICE guidance.

Practice appears to be in line with guidance National

Royal College of General Practitioners (2011) National Audit of Cancer Diagnosis in Primary Care 2011

Description: The aim of this audit was to define current practice in primary care cancer diagnosis. The audit was conducted between April 2009 and April 2010. Data was collected on 18879 patients by 1170 practices from 20 out of 28 cancer networks. The duration of the primary care and referral intervals showed considerable variation by cancer site. Emergency presentation, usually associated with worse outcomes, occurred in 12.9% of all cases but ranged from 3.7% (breast) to 39.3% (brain).

Doubts about or mixed impact in practice National

The Royal College of Surgeons of England (2012) National Oesophago-Gastric Cancer Audit 2012

Description: This audit presents findings from a questionnaire sent in February 2012 to clinical leads of Cancer Networks and NHS organisations providing care for oesophago-gastric cancer in England and Wales, which examined organisational policies and operational procedures. In terms of approaches to care for people in the last days of life, most NHS organisations had implemented some combination of end-of-life care, with NICE guidance being implemented by 68 (50%) of the 137/151 organisations to respond.

Doubts about or mixed impact in practice National

Baughan, P. et al (2011) Urgent suspected cancer referrals from general practice: audit of compliance with guidelines and referral outcomes Br J Gen Pract. 2011 Nov;61(592):e700-6

Description: Results are presented from a prospective audit within general practice in Scotland, which measured patterns of suspected cancer referrals against guidance. GPs in Scotland reviewed all urgent suspected cancer referrals over a 6 month period in early 2008 - a total of 18,775 referrals were analysed from 516 GP practices. The study found 90.9% compliance with referral guidelines. However, a large proportion of referrals considered to be outside the guidelines still had a cancer diagnosed.

Practice appears to be in line with guidance Local

Biswas, S. et al (2013) Impact of Primary Care Education on the Two Week wait Referral Process for GI Cancers Gut 2013; 62:A47

Description: The appropriateness of two week wait gastrointestinal (GI) referrals to the Horton General Hospital, Oxford between December 2011 and February 2012 were assessed. A presentation was given to Primary Care Practitioners in May 2012 highlighting NICE guidance and referrals were re-audited in June 2012. Results found that 24% of Upper GI and 26% of Lower GI referrals were non-compliant with guidance. In June 2012 compliance improved to 81% of upper GI and 79% of lower GI referrals.

Practice appears to be in line with guidance Local

This page was last updated: 01 January 2013

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Selected, reliable information for health and social care in one place

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.