Improving early diagnosis of symptomatic cancer

Key Points

  • Very few randomized controlled trials have investigated whether expediting the diagnosis of symptomatic cancer improves the outcomes of patients; however, observational evidence is indicative of clinical benefit for some patients

  • Awareness campaigns often prompt earlier presentation of patients with cancer to the health-care system, although the long-term effect of this earlier presentation is largely unknown

  • Rapid access to specialist expertise, coupled with national guidance for selection of patients for investigation of possible cancer — and, subsequently, clinical decision support — might result in shorter times to diagnosis

  • The UK National Institute of Health and Care Excellence recommend an explicit risk threshold of 3% for investigation of cancer in symptomatic patients, this liberalisation will influence the spectrum of patients seen by specialists

  • The cost-effectiveness of initiatives to expedite diagnosis of symptomatic cancer is markedly under-researched

Abstract

Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.

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All authors made a substantial contribution to researching data for this article, discussions of content, writing the manuscript, and reviewing and/or editing the manuscript prior to submission.

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Correspondence to Willie Hamilton.

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W.H. was the clinical lead for the recent NICE guidance, NG12, on selection of patients for investigation for possible cancer. W.H. and G.R. have acted as consultants for Medx. The other authors declare no competing interests.

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Hamilton, W., Walter, F., Rubin, G. et al. Improving early diagnosis of symptomatic cancer. Nat Rev Clin Oncol 13, 740–749 (2016). https://doi.org/10.1038/nrclinonc.2016.109

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