The British Association of Oral and Maxillofacial Surgeons (BAOMS) is calling for a root and branch examination of the fast track GP cancer referrals target, amid fears that the large number of patients referred under the National Institute for Health and Care Excellence (NICE) two week wait rules are overwhelming the NHS and delaying access to treatment for those patients who actually have cancer.
Writing in the February issue of the British Journal of Oral and Maxillofacial Surgery (BJOMS), senior facial surgeon and BJOMS Editor David Mitchell says: “The evidence shows that as few as 6.6 per cent of fast track GP cancer referrals are actually cancers, and nearly half of all new cancers are diagnosed by conventional methods. An urgent review is needed now to stop this target driven system delaying the treatment of patients who actually have mouth cancer.”
David Mitchell and colleagues say that the Urgent Suspected Cancer (USC) pathway does not work: “I am surprised that the Department of Health accepts a mere 3 per cent rate of cancer detection using the USC pathway, despite the extra pressure this is putting on an already fractured health service. This is non-evidence based politics, not evidence based medicine.”
There are about 8,000 cases of head and neck cancer (HNC) in the UK every year, but the incidence of throat cancer (oropharyngeal) has doubled over the past two decades. A study published in the February issue of BJOMS, and simultaneously in Clinical Otolaryngology, found that detection via the two week pathway “remains low which is in keeping with previous studies”. The authors, Theofano Tikka and Vinidh Paleri, conclude that the current referral criteria can be refined significantly to improve “diagnostic efficacy”.
Mike Davidson, BAOMS Chair and consultant maxillofacial surgeon, has welcomed the research, but admits he is shocked at the findings that show fewer patients are having their cancers diagnosed in a timely way: “It is astonishing to learn that the NICE guidance, promoted as a way of improving cancer detection rates, is actually resulting in fewer HNC cancers being diagnosed. The confusion between the 2000 and 2005 guidelines, and leaving out key diagnostic criteria in the 2015 version, are causing different referral patterns depending where in the UK the patient lives. This is yet another example of the postcode lottery affecting patient care.
“A review of all the NICE guidance is needed urgently if we are to ensure people with mouth and neck cancers are diagnosed and treated promptly, as they should be.”