Evidence
Overview of 2019 surveillance methods
Overview of 2019 surveillance methods
NICE's surveillance team checked whether recommendations in the NICE guideline on suspected cancer: recognition and referral remain up to date.
The surveillance process consisted of:
-
Feedback from topic experts via a questionnaire.
-
A search for new or updated Cochrane reviews.
-
Examining related NICE guidance and quality standards and National Institute for Health Research (NIHR) signals.
-
A search for ongoing research.
-
Examining the NICE event tracker for relevant ongoing and published events.
-
Literature searches to identify relevant evidence.
-
Assessing the new evidence against current recommendations to determine whether or not to update sections of the guideline, or the whole guideline.
-
Consulting on the proposal with stakeholders.
-
Considering comments received during consultation and making any necessary changes to the proposal.
For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.
Evidence considered in surveillance
Search and selection strategy
We searched for new evidence related to the whole guideline.
We found 62 studies in a search for primary care-based studies published between January 2014 and August 2019. Twelve relevant studies from a total of 14 identified by topic experts were also considered relevant but they were already included in our searches. Three relevant studies were identified in comments received during consultation on the 2019 surveillance review and were included. From all sources, we considered 65 studies to be relevant to the guideline.
See appendix A for details of all evidence considered, and references.
Selecting relevant studies
We included only primary care-based studies, as people with symptoms in primary care were the population of relevance to this guideline. We included relevant references that described important information about cancer symptoms in their abstracts such as positive predictive values, sensitivities, specificities, likelihood ratios, or odds ratios. We also included primary care-based studies on investigations for cancer in primary care following the same inclusion criteria used for cancer symptoms.
Ongoing research
We checked for relevant ongoing research; of the ongoing studies identified, 5 were assessed as having the potential to change recommendations. Therefore, we plan to regularly check whether these studies have published results and evaluate the impact of the results on current recommendations as quickly as possible. These studies are:
-
Raman spectroscopy and colorectal cancer
-
This is a randomised controlled trial assessing the diagnostic accuracy of the Raman spectroscopy test, which is a blood test that can be used in primary care in symptomatic patients to achieve an earlier diagnosis of bowel cancer.
-
-
FIT – Can a dipstick test rule out bowel cancer?
-
This is a non-randomised diagnostic study assessing the accuracy of the faecal immunochemical test to triage symptomatic patients for a suspected cancer referral for bowel cancer in primary care.
-
-
Biomarkers for ovarian cancer risk assessment
-
This is a case series pilot study assessing the accuracy of ovarian cancer biomarkers in risk assessment of symptomatic patients in primary care.
-
-
CANcer DIagnosis Decision rules
-
This is an observational cohort study aiming to identify alarm symptoms and signs for early prediction of lung and colon cancer.
-
-
Electronic risk assessment for cancer for patients in general practice
-
This is pragmatic cluster randomised controlled trial investigating the effectiveness of electronic risk assessment tools for lung, colorectal oesophago-gastric, bladder, kidney, and ovarian cancer in primary care.
-
Intelligence gathered during surveillance
Views of topic experts
We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.
We sent questionnaires to 14 topic experts and received 8 responses. The topic experts who provided feedback were: GPs, a public health consultant, a clinical reader, a consultant radiologist, and a consultant oncologist. We also received feedback from Macmillan Cancer Support and their GP Advisors (1 questionnaire received).
Overall, 4 topic experts thought that the guideline should be updated and 4 thought that an update was not necessary. The issues that topic experts thought could be addressed in an update are discussed in detail in appendix A and in the reasons for the decision section.
Implementation of the guideline
A total of 6 experts provided information on the implementation of the guideline. Overall, it was considered that the guideline is well implemented. Also, resources such as the cancer maps, which summarise NICE guideline NG12 recommendations, were highlighted as very valuable for the implementation of the guideline in primary care.
Views of stakeholders
Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because this surveillance proposal was to not update the guideline, we consulted with stakeholders.
Overall, 29 stakeholders commented.
Eleven stakeholders agreed with the decision not to update the guideline. These included 1 charity, 1 pharmaceutical company, 8 professional bodies, and 1 provider of services.
Eighteen stakeholders disagreed with the decision not to update the guideline. These included 6 charities, 1 commercial organisation, 4 professional bodies, 6 providers of services, and 1 university.
Key points raised during stakeholder consultation included:
-
Oral cancer and the lack of a formal referral process from primary care to the dentist.
-
Colorectal cancer and low-risk symptoms profile for faecal immunochemical testing.
-
Prostate cancer and age-specific reference range for prostate-specific antigen levels.
-
Rapid diagnostic centres and new cancer pathways.
These issues are discussed in detail in the reasons for the decision section. Also see appendix B for full details of stakeholders' comments and our responses.
See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.
Equalities
Stakeholders highlighted 1 issue related to the access to dental services for people presenting with symptoms of oral cancer that require further assessment by a dentist to determinate if suspected cancer referral for oral cancer is needed. This issue is discussed in the oral cancer section.
This page was last updated: