The path to see a cancer specialist isn’t always the same for every cancer patient. As it turns out, certain groups of patients may have a longer road to the hospital than others.
A new survey of more than 41,000 cancer patients in the United Kingdom revealed that 77 percent of patients who visited a family doctor when they first experienced symptoms were referred to a specialist after only one or two consultations.
But for women, young patients, ethnic minorities, and people with less common types of cancers – such as multiple myeloma, pancreatic, stomach, and ovarian cancer – they were more likely to visit a doctor two or three times before they were referred to a hospital.
“The bottom line is we need to prioritize research on the diagnosis of cancer,” said Georgios Lyratzopoulos, clinical senior research associate at the University of Cambridge and lead investigator for the study. “We’re highlighting the limitations of the cancer research model. What has been forgotten implicitly is research to develop the better understanding of how people with cancer present – what is called ‘symptom signature.’”
The findings were a result of secondary analysis of the English National Cancer Patient Experience Survey done on cancer patients with 24 different cancers in 2010. While the research is specific to U.K. doctors and hospitals, Lyratzopoulos said he is certain the trends he discovered will be echoed in future research conducted in the United States and beyond.
“It’s a global issue; it’s not something that only affects the UK,” Lyratzopoulos said. “I imagine after this paper is published and it percolates to our scientific peers, there will be some emulation of this work.”
The researchers only presented the patterns they discovered, but Lyratzopoulos and his colleagues proposed some preliminary theories as to why the trends existed. For one, they believe that doctors are less likely to suspect cancer in younger patients because demographically, they typically have lower cancer rates.
The same goes for perceptions of women and cancer risk, according to the researchers. Comparatively, women have lower rates of cancer than men, so doctors may have a tendency to consider the possibility of cancer later than they should.
“What it demonstrates is that doctors do kind of know these trends and internalize it in some generalized way,” Lyratzopoulos said. “They pass judgment in a way that they shouldn’t. That’s the theory anyway; we have no data for this, but that’s what we put in the paper.”
But the real problem, Lyratzopoulos said, lies in the lack of knowledge surrounding diagnosis. For bladder cancer, women were twice as likely as men to visit their doctor three or more times before getting a hospital referral. The researchers felt this represented the difficulty for some doctors to differentiate between symptoms of bladder cancer and bladder infection or other generic gynecological conditions.
Also, patients who had a little known cancer called multiple myeloma were 18 times more likely to require three or more pre-referral visits from their family doctor. Multiple myeloma is a blood cancer that mimics many other conditions, making it difficult for doctors to diagnose.
The Multiple Myeloma Research Foundation (MMRF) said studies like these highlight the need for physicians to be better educated in the various cancer screening techniques, especially for the lesser known cancers.
“It’s unusual for a primary care doctor to make the diagnosis [of multiple myeloma], but to be able to pick up on the initial signs is something that should be incorporated [in cancer screenings],” said Anne Young, vice president of strategic alliances for MMRF. “Don’t just look at the typical results, but look at protein levels.” This technique can help to better detect multiple myeloma.
Dr. Brett Ruffo, a colorectal surgeon at Peconic Bay Medical Center in Riverhead, NY, said this research not only highlights the need for better education in physicians – but also in patients.
“The education has to go far from just the physicians; education goes from the doctors to the nursing staff to community outreach centers and so on,” Ruffo said. “That’s why we’re trying to create these big comprehensive programs – where we partner up with hospitals and physicians to allow a multi-disciplinary team of doctors to be available at all times for information. It would allow us to reach out the community to discuss a whole range of cancer topics.”
Lyratzopoulos and his colleagues echoed this sentiment, including recommendations in their paper for both doctors and policy makers in order to alleviate diagnosis problems. They suggested a need for clinicians to be more aware of the disparity in patient group diagnosis, as well as participate in more benchmark data collection. They also recommended to policy makers re-evaluating medical education requirements and a system re-design that would allow more use of diagnostic tests.
Overall, according to the researchers, it is crucial to shorten the diagnosis process as much as possible, because the earlier the diagnosis, the better chances for the patient’s survival.
“We need to move away from the idea that we just need to treat cancer better,” Lyratzopoulos said. “While treating cancer is important, prompt diagnosis can make treatment much more effective.”
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