Introduction

This quality standard covers recognition of suspected cancer in adults, young people and children, and referral to specialist services. For more information see the suspected cancer topic overview.

Why this quality standard is needed

Cancer is a condition in which cells in a specific part of the body grow and reproduce uncontrollably. Cancerous cells can invade and destroy surrounding tissue, including internal organs. There are over 200 types of cancer, many of which have different methods for diagnosis and treatment.

Cancer has an enormous impact, both in terms of the number of people affected by it and the impact it has on people with cancer and those close to them. Approximately one‑third of the population will develop a cancer in their lifetime and more than 300,000 new cancers (excluding skin cancers) are diagnosed annually in the UK. Each cancer type can have different presenting features, though they sometimes overlap. There is considerable variation in referral and testing rates for suspected cancer, which cannot be fully explained by variation in the population.

The identification of people with suspected cancer usually happens in primary care, because most people first present to a primary care health professional. Some investigations for suspected cancer can be performed in primary care, for example, blood tests such as prostate-specific antigen tests for prostate cancer or CA125 tests for ovarian cancer. Imaging investigations, such as chest X-rays or ultrasound, are generally available by direct access[1] from GPs. However, some investigations, such as colonoscopy and biopsy, can be accessed only through secondary care and so need formal referral.

This quality standard is expected to contribute to improvements in the following outcomes:

  • time to cancer diagnosis

  • cancer diagnosed at stage 1 or 2

  • cancer-related morbidity

  • cancer-related mortality.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

1b Life expectancy at 75

i Males ii Females

Improvement areas

Reducing premature mortality from the major causes of death

1.4 Under 75 mortality rate from cancer* (PHOF 4.5)

i One- and ii Five-year survival from all cancers

iii One- and iv Five-year survival from breast, lung and colorectal cancer

v One- and vi Five-year survival from cancers diagnosed at stage 1 & 2** (PHOF 2.19)

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

4d Patient experience characterised as poor or worse

i. Primary care

Improvement areas

Improving access to primary care services

4.4 Access to i GP services

Improving people's experience of integrated care

4.9 People's experience of integrated care**

Alignment across the health and social care system

* Indicator is shared.

** Indicator is complementary.

Indicators in italics in development.

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.19 Cancer diagnosed at stage 1 and 2**(NHSOF 1.4) 2.20 Cancer screening coverage

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.3 Mortality rate from causes considered preventable **(NHSOF 1a)

4.5 Under 75 mortality rate from cancer*

Alignment across the health and social care system

* Indicator is shared.

** Indicator is complementary.

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to suspected cancer.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to people using services. Quality statements on these aspects of patient experience are not usually included in topic-specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for suspected cancer specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole cancer care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to people with suspected cancer.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality cancer service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing and referring people with suspected cancer should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with suspected cancer. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.



[1] Please note that direct access may also be called "straight to test" or similar.