Primary Care Cancer Toolkit

This Primary Care Cancer Toolkit provides a collection of key resources about cancer prevention, diagnosis and care relevant for the primary care setting. It provides links to current guidance, continuing professional development resources, patient information, and information for those involved in commissioning.

The Primary Care Cancer Toolkit has been developed by the RCGP in collaboration with Cancer Research UK as part of our partnership to raise awareness and knowledge of the role of primary care in cancer control. It is designed for use by primary healthcare professionals in the UK. If you are accessing these resources from outside the UK, bear in mind that guidelines and systems may be different.

Resources are split into professional and patient sections. Professional resources consist of guidelines, information and tools aimed at those working in primary healthcare. Those within the patient section are websites, information leaflets and other resources aimed at a public audience which a healthcare professional can signpost patients to during or post consultation.

Cancer Prevention

The UK is facing a 20% increase in cancer incidence by 2030, largely because of a growing ageing population. But more than 4 in 10 cases of cancer could be prevented largely through changes to lifestyle, so addressing preventable risk factors is crucial.

Even brief interventions which can be managed opportunistically within a GP consult such as those recommended by the National Institute of Health and Care Excellence (NICE) for smoking cessation have been shown to be effective in encouraging lifestyle change.

More information on the causes of cancer 

Professional

Reducing Risk - Healthy Lifestyle and Wellbeing

NICE

NHS

  • NHS Health Scotland – Provides information, education and support for health professionals interested in the ‘Keep Well’ programme in Scotland

Guidelines for Changing Behaviour

NICE

NHS

RCGP

Risk Factor Specific Guidance

Smoking

Smoking is the single largest preventable cause of cancer. There are some excellent targeted resources for becoming smoke free.

NHS

Cancer Research UK

Other

Weight

Overweight and obesity is the second biggest preventable cause of cancer.

NICE

NHS

Cancer Research UK

Alcohol

Every year alcohol causes 4% of cancers in the UK, around 12,800 cases.

NICE

NHS

Cancer Research UK

Diet

A healthy, balanced diet is one that is high in vegetables, fruit, wholegrains and pulses and low in processed or red meat. Not only does it help weight management, it can also reduce the risk of cancer directly.

NHS

Cancer Research UK

Physical Activity

It is thought that keeping active could help prevent around 3,400 cases of cancer every year in the UK.

NHS

Cancer Research UK

HPV Infection

Up to 8 out of 10 people will be infected with the virus at some point in their lives. There are hundreds of different types of HPV and most are harmless. But around 12 types of HPV can cause cancer.

NHS

Cancer Research UK

Other

Sun Safety

In the UK more than 8 in 10 cases of melanoma, the most serious type of skin cancer, could be prevented through enjoying the sun safely and avoiding sunburn.

Cancer Research UK

Patient

Healthy Living Resources for Patients

NHS

  • NHS Choices: Live Well Hub – Advice and suggestions aimed at the general public about lifestyle changes, many of them related to cancer prevention

Other

  • Change4Life – Information on increasing physical activity and healthy eating

Cancer Research UK

Cancer Screening

Screening involves testing apparently healthy people for signs of disease. It can save lives through detecting cancer at an early stage, or even preventing it. Currently in the UK there are national screening programmes for breast, bowel and cervical cancer.

Effective population-based screening programmes need a high level of sensitivity (the ability to correctly identify a change) and specificity (the ability to correctly identify people who do not have a change).

Screening has harms as well as benefits and  it’s important that primary healthcare professionals are able to help patients make informed decisions and choose whether screening is right for them. Vulnerable groups, including people with learning disabilities; people with physical disabilities; people with sensory impairments; younger relatives and carers; and people who do not read/write English, may require additional support in accessing information about screening participation.

View a full version of the cancer screening programmes grid

For further information on screening programmes, see the Cancer Research UK Screening Webpages: Understanding Cancer Screening and the UK Government: Screening Programmes Webpages.

Devolved Nations

Professional

Cancer Specific Screening Guidance

Breast

The NHS Breast Screening programme invites all women between 50 and 70 years for screening every 3 years. In some parts of England, PHE has been trialling inviting women aged 47 to 73 years old.

Information

Bowel

The NHS Bowel Cancer Screening programme offers home screening kits every two years to all men and women aged 60 to 74, and NHS Scotland offers these from age 50. In England men and women aged 55 are also invited for a one off bowel scope screening test.

Information

Tools

Cervical

The NHS cervical screening programme invites women from ages 25 to 64 for cervical screening. Women aged 25 to 49 are invited every 3 years. After that, women are invited every 5 years until the age of 64.

Information

Tools

Balancing Benefits and Risks of Screening

Prostate Cancer

There is not currently a national screening programme for prostate cancer, however men over 50 can request a test. It is important that they make an informed decision on whether or not to request a test, and this infographic can help.

Patient

Understanding and Accessing Screening

Early Diagnosis and Referral

Finding and treating cancer when it is at an early stage provides the best chance of effective treatment. For example, more than 9 out of 10 people will survive bowel cancer if diagnosed at stage 1, as opposed to just 4 out of 10 when diagnosed at stage 4.

Patients with signs and symptoms suggestive of cancer should be referred for investigation according to national and local guidelines. Current NICE guidelines for England, Wales and Northern Ireland recommend the threshold for referral being a 3% risk of cancer. It is important to recognise that, at this threshold, most referrals for suspected cancer will not lead to a cancer diagnosis.

Professional

Diagnosis and Referral Guidance

Information

Tools

Cancer Site Specific Guidance

Decision Support and Safety Netting

Cancer symptoms are complex and can be vague and non-specific. An increasing number of decision support tools have been developed to aid in assessing a person’s risk. These are designed to be used as an adjunct to, and not a replacement for, clinical judgement and current guidance. It is important to remember that people at low risk still have a risk. Effective safety netting will help to bring those people back promptly if symptoms do not improve, or if new symptoms develop.

CRUK

Other

Patient

Patient Information of Signs and Symptoms

Providing patients with cancer awareness information is a good way to increase their confidence to spot signs and symptoms and to know when to visit the doctor.

CRUK

NHS

Other

Patient Information on Referral for Investigation

CRUK

Further Information on ‘Early Diagnosis’ activities at Cancer Research UK can be found in the bi-monthly Early Diagnosis newsletter. Subscribe to this newsletter here.

Treatment

Treatment for cancer is mainly led by secondary care, however, people will still visit their own GP during and after treatment.

Some people undergoing treatment for cancer want to discuss treatment options or gain advice on letters full of medical jargon. Many will have physical or mental health comorbidities which continue to be managed in primary care. For some patients, cancer and its treatment can lead to presentations for new or evolving symptoms, including oncological emergencies. At other times, patients simply need support and reassurance.

Professional

Cancer Treatment

Both Cancer Research UK and Macmillan have excellent information on their websites about what to expect from treatment. This patient information is also very informative for healthcare professionals.

Cancer Emergencies

Beyond Cancer and End of Life Care

Patients who have had a cancer diagnosis have an increased lifetime risk of developing another cancer. All the advice in the prevention section is relevant to this group. GPs should be proactive in lifestyle advice in those living with or beyond cancer and be alert to symptoms of recurrence or second primary cancers.

More information about coping with cancer (including coping physically, emotionally, practically and talking about dying).

Professional

Consequences of Cancer

  • The Consequences of Cancer Toolkit – Developed by the RCGP in collaboration with Macmillan contains resources relating to identifying and managing the consequences of cancer treatment and supporting patients to live well after a cancer diagnosis

Survivorship

End of Life Care

Despite current progress, there are inevitably patients who die from cancer. Providing support and good medical care to those dying in the community continues to be the role of GPs although increasingly supported by teams of other healthcare professionals.

Cancer Information for Patients Carers and Professionals

If you or a loved one is affected by cancer you want to be able to access jargon-free reliable information relevant to you.

This section of the toolkit aims to signpost you to these resources or to help your GP find them on your behalf. Much of the information is extremely detailed and will also be very useful for healthcare professionals.

If you notice any change to your body that’s not normal for you or doesn’t go away, always speak to your doctor. If you have seen your doctor but your symptoms don’t go away, go back and see your doctor.

Patient

Patient Friendly Information

CRUK

NHS

  • NHS: Cancer Information and Useful Links – A good source of reliable information for patients and carers, including what people can do to reduce their risk of cancer.

  • NHS Inform: A good source of information for patients, public and health professionals in Scotland

Macmillan Cancer Support

Debunking the Myths

  • Cancer Research UK Blog – Provides up-to-date views on new developments and helps give an evidence based perspective on common myths and misconceptions about cancer
  • CRUK: Cancer controversies – information about common cancer controversies

Support for Carers

Looking after someone with cancer is not always easy but there is information and support available to help your patients with day-to-day care, psychological support and with practical matters such as finances and getting to appointments. Your GP should be able to direct you to local support but below are some good starting points for directing patients to appropriate support and resources.

Continued Professional Development Training and Appraisal

Cancer is an evolving area of practice with new developments both in the background science and in treatments and care pathways. It is therefore vital to keep up to date.

Professional

Educational Events

Face-to-Face Learning Events

E-Learning

Cancer Research UK

Cancer Research UK in Association with Doctors.net.uk

RCGP Cancer Education Hub

BMA

  • Variety of CPD Modules – Available to those with a BMA membership, includes many modules relevant to cancer

Audit and Quality Improvement

The Quality and Evidence Personal Excellence Pathway (QEPEP) Toolkit - this toolkit is tailored for QEPEP use at the University of Manchester, however principles of QIP facilitation within it are universal and maybe applicable to other programmes.

Improving Diagnosis of Cancer: A Toolkit for General Practice

Significant event audit of all emergency presentation of cancer is a recommendation from the national cancer taskforce in England and a part of the GMS contract in Wales. It is a useful way to learn from cases and improve care. Ideally significant event audits in these cases should be done across primary and secondary care

National Cancer Diagnosis Audit

The National Cancer Diagnosis Audit (NCDA) helps us to gain new insights into patient pathways to cancer diagnosis and can inform service improvements that will help to diagnose cancers earlier.

How does it work?

The NCDA gathers primary and secondary care data to explore patient pathways to cancer diagnosis. The last audit round took place in 2016/17 using 2014 data.

The audit looks at clinical practice to understand:

  • Interval length from patient presentation at the surgery to diagnosis

  • Use of primary care led investigations prior to referral

  • What the referral pathways for patients with cancer are, and how they compare with those recorded by the cancer registry

What’s next?

  • A publication summarising the findings from the most recent round of the NCDA is expected soon in the British Journal of General Practice.

  • The next round of the NCDA is planned for early 2019.

To find out more:

Clinical Cases

Practical Profiles

  • Fingertips Public Health England Website – Allows GPs in England to obtain practice level data on how they are doing in cancer care. It allows practice date to be compared with CCG and national averages and other practices. It is a useful tool to look for areas of quality improvement

Local Cancer Statistics

Resources for those Commissioning or Planning Cancer Services

Many GPs will also be involved through clinical commissioning groups and other organisations in commissioning and/or planning cancer services.

This area of the toolkit contains resources relating to this. Commissioners and planners should consider the benefits of preventative interventions as well as effective pathways for diagnosis and management.

Professional

Current Policy

Policy Directions

England

Scotland

  • Beating Cancer: Ambition and Action – The new Scottish cancer strategy sets out a 5-10 year plan to tackle cancer by improving prevention, detection, diagnosis and treatment and after care for those affected.

Wales

  • Cancer Services in Wales – Makes recommendations for how to improve cancer outcomes in Wales, and includes recommendations for, and relevant to, primary care.

Service Capacity

Cancer Research UK have undertaken several pieces of work in recent years around service capacity in secondary care, as well as cost benefits of earlier diagnosis of cancer. Reports from these can be found on their website.

Where to Find Support for Improvement Activity 

There are various sources of help and support for practices or CCGs in working to improve cancer care.

RCGP CIRC Clinical Priority Programme

Cancer Research UK Health Professional Facilitator Programme

  • The Facilitator Programme – Enables facilitators to work in partnership with NHS Commissioners, GP Cancer Leads, Public Health and other local bodies to support primary care in the prevention, early diagnosis and optimal management of cancer.

Cancer Research UK Strategic GP Leads

  • Lead GPs working with Strategic Clinical Networks and Cancer Alliances in England. Contact primarycare@cancer.org.uk for further details.

Macmillan GPs

  • Macmillan GPs are practising GPs who devote an average of a day per week to work with Macmillan to make a recognisable improvement in cancer care across the UK

Cascade

Quality Improvement

Data to Inform Improvement Activity

Upcoming Primary Care Cancer Events

The enhanced role of primary care in cancer control workshop

 Thursday 6 September 2018 - Edinburgh

The RCGP and Cancer Research UK invite you to attend a one day workshop focused on the enhanced role of primary care in cancer control. This workshop will consist of a keynote speaker, Dr Richard Roope (RCGP and CRUK Clinical Champion for Cancer) and local cancer clinical leaders.

There will be opportunities for group work, networking and reflection of how the event content will support your practice.

By the end of the workshop attendees will have:

  • Increased awareness and knowledge of primary care cancer control
  • Improved knowledge and understanding of early recognition and referral of symptoms of suspected cancer
  • Up to date knowledge of CRUK and RCGP support focused on cancer prevention and early diagnosis

Workshops across the UK:

  • 29 November 2018, Bradford
  • 31 January 2019, Birmingham
  • 06 February 2019, Luton
  • 13 March 2019, Belfast

Further information about these events, including links to registration pages, will be made available in due course.

This toolkit has been developed in partnership between the RCGP Clinical Innovation and Research Centre and Cancer Research UK.

Please send any feedback or suggestions to circ@rcgp.org.uk

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