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 (4 October 2021)

Summary

Clinical guidelines advise GPs in England which patients need urgent referral for suspected cancer. This study in BMJ Quality & Safety used linked primary care, secondary care and cancer registration data to assess:

• how often GPs follow the guidelines on cancer referral
• whether certain patients are less likely to be referred
• how many patients were diagnosed with cancer within one year of non-referral.

The study included patients who presented for the first time with blood in the urine, breast lump, difficulty swallowing, iron-deficiency anaemia and post-menopausal or rectal bleeding during 2014–2015.

The authors found that the majority of patients presenting with common possible cancer symptoms were not being referred by GPs in line with clinical guidelines. They also found that a significant number of these patients went on to develop cancer within a year, and suggest that improvement is needed in the cancer diagnosis process.