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Referral Guidance for Suspected Cancers1_16

VIEWS: 9 PAGES: 16

									Referral Guidance for
 Suspected Cancers
                   OVERVIEW
Cancer in Northern Ireland – the facts

The purpose of the guidance

The importance of prompt and appropriate referral

An illustration - lung

Receipt & management of “red flags” in secondary care

Audit & primary care liaison
CANCER IN
NORTHERN IRELAND
8,500 new cancers diagnosed annually
3,600 deaths each year
40,000 living with diagnosis of cancer

Either sex have 1 in 3 chance of developing some
form of cancer by age 75
Deprived areas experience more cancers of the
lung, cervix and stomach than average but less
cancer of breast or skin
  8,500 people diagnosed annually with cancer
  but many more present with symptoms which
• 8,500 new cancers diagnosed annually
  are found on investigation not to be cancer.
• 3,600 deaths each year
  Estimated ratio of diagnosis and 15:1
• 40,000 living with 3:1 for lungof cancer for
  breast & colorectal.

  These people undergo the same anxiety and
  investigative services as those people who
  have cancer, until they are told they do not
  have cancer.
 Primary Care Cancer Epidemiology

                          Individual GP   Group Practice

Population                   1,600            10,000

New cases p.a.                 7-8             50

Patients with cancer         30-40             200
diagnosis
Deaths from cancer p.a.        4               25

Home deaths from               1                6
cancer
Tumour type   Incidence per 2000 list size

Lung          1 case every 9 months

Breast        1 case every year

Colorectal    1 case every year

Prostate      1 case every 18 months
By 2025 ….
Cancer levels will be 1.5 times
higher than today
   • Prostate - doubled
   • Colon - reduced
   • Melanoma - increased 50%
   • Breast – increased 40%
   • Lung – increased 10%

  All cancers to increase by 30% if tobacco levels not
  reduced, by 18% if tobacco levels fall
ABOUT THE GUIDANCE
Purpose Of Referral Guidance


  To facilitate appropriate referral between primary
         & secondary care for patients whom a GP
                         suspects may have cancer

        To improve cooperation & communication
  between general practice and the hospital sector

   To promote a better quality of care for people in
                                   Northern Ireland
                            THE PATIENT PATHWAY



Patients Perspective
                               Seeing
     Thinking                                               Getting better     Being
                              someone        Being told
   something is                                              & living with    followed
                               & having     what is wrong
      wrong                                                 condition          up
                                tests
Professionals Perspective

                            Consultation
       Referral                  &           Diagnosis      Treatment         Follow up
                            Investigation



 NICaN is working towards the development of a pathway underpinned by quality and
 evidence based standards – organisational and clinical - and inclusive of the Departments
 mandatory cancer access standards
                            THE PATIENT PATHWAY

                               Timed Access Standards


Patients Perspective
                               Seeing
     Thinking                                                     Getting better         Being
                              someone         Being told
   something is                                                    & living with        followed
                               & having      what is wrong
      wrong                                                       condition              up
                                tests
Professionals Perspective

                            Consultation
       Referral                  &             Diagnosis          Treatment             Follow up
                            Investigation



 A pathway underpinned by quality and evidence based standards – organisational and clinical - and
 inclusive of the Departments mandatory cancer access standards
                            THE PATIENT PATHWAY

         Primary care guidance + timed access standards


Patients Perspective
                               Seeing
     Thinking                                                     Getting better         Being
                              someone        Being told
   something is                                                    & living with        followed
                               & having     what is wrong
      wrong                                                       condition              up
                                tests
Professionals Perspective

                            Consultation
       Referral                  &            Diagnosis           Treatment             Follow up
                            Investigation



 A pathway underpinned by quality and evidence based standards – organisational and clinical - and
 inclusive of the Departments mandatory cancer access standards
      THE GUIDANCE
Referral processes for 13 cancers

Evidence-based (NICE, Prodigy)

Developed and ratified by NICaN tumour groups
    Regional
    Multidisciplinary
    Secondary & primary care involvement
    Patient input

Available at www.nican.n-i.nhs.uk and on your
Board intranet site
The key priorities for
implementation

making a diagnosis

avoiding unnecessary investigations

provision of support and information

continuing education for professionals
                        Making a referral

be familiar with typical presenting features
be alert to unusual symptom patterns and
when patients thought not to have cancer
                fail to recover as expected
  discuss with a specialist when uncertain
  cancer is uncommon in children, and its
detection can present particular difficulties
                              Investigations

investigations in primary care should not be
         allowed to delay referral in patients
              with features typical of cancer
      in patients with less typical symptoms
        investigations may be necessary but
              should be undertaken urgently
     if specific investigations are not readily
               available locally, refer urgently

								
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