Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records

Guidelines in England advise GPs to refer patients who present with certain symptoms of possible cancer to specialist services within 2 weeks. Evidence suggests that these guidelines are helping to improve diagnostic processes and outcomes for patients, but the extent to which they are adhered to is unknown. This study used linked data from primary care, secondary care, and cancer registries, to assess how often GPs follow the guidelines, whether certain patients are less likely to be referred, and how many patients were diagnosed with cancer within 1 year of non-referral. From over 48,000 patients included in the study, 40% received an urgent referral within 14 days of presentation. Younger patients (18-24) and those with comorbidities were less likely to receive a referral. Of the included patients that didn’t receive a referral, 3.6% (>1000) were diagnosed with cancer within 1 year. The results of this study indicate that guideline recommendations for action are not followed for the majority of patients presenting with common possible cancer features. A significant number of these patients developed cancer within 1 year of their consultation, indicating scope for improvement in the diagnostic process. Read full text
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