Primary Care Cancer Toolkit

This Primary Care Cancer Toolkit provides a collection of key evidence-based 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.

If you are interested in your practice taking part in 2016's National Cancer Diagnosis Audit, please find out more and register here.

Cancer prevention

It is estimated that 4 in 10 cases of cancer could be prevented.  If unaddressed, the UK is facing a 20% increase in cancer incidence by 2030. Learn more about the burden of cancer in the UK.

View a full version of the '4 in 10 cancers can be prevented' factsheet

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 

Guidelines for behaviour change

Guidance for reducing risk

General patient resources on healthy lifestyle

Information and guidance on specific risk factors

Smoking cessation

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

Keeping weight within healthy range

It is thought that more than 1 in 20 cancer cases in the UK are linked to being overweight or obese.

Alcohol

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

Diet

Experts think that nearly 1 in 10 UK cancer cases could be prevented through healthy diets. To reduce the risk of cancer, people should eat a healthy, balanced diet that's high in fibre, fruit and vegetables, and low in processed and red meat, and salt.

Physical activity

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

HPV infections

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 13 types of HPV can cause cancer.

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 screening

Screening involves testing apparently healthy people for signs of disease in order to identify lesions or early cancers that can be treated effectively.  Currently in the UK there are universal 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 lesion/change) and specificity (the ability to correctly identify people who do not have a lesion/change).

National Cancer Screening programmes at a glance

View a full version of the cancer screening programmes grid

It is important that primary healthcare professionals are able to help patients make informed decisions and choose whether screening is right for them. It is important to support vulnerable groups in accessing and being informed about participation in screening groups. This includes: people with learning disabilities; people with physical disabilities; people with sensory impairments; younger relatives and carers; and people who do not read/write English.

Patients or clinicians may have concerns about genetic risks of cancer.

More information on cancer screening

National screening guidance

UK Government Screening programs website with information on all the national screening programs including those aimed at early detection/prevention of cancer.

Devolved nations

Breast cancer screening

Bowel cancer screening

Cervical cancer screening

Balancing the benefits / risks of screening

Patient information

Early diagnosis and referral

Finding and treating cancer when it is at an early stage provides the best chance of effective treatment.

For example, 9 out of 10 people will survive bowel cancer if diagnosed at the earliest stage. Patients with signs and symptoms suggestive of cancer should be referred for further 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.


View a full version of the NICE Suspected Cancer Recognition and Referral Symptom Reference Guide

Symptom recognition and referral guidance

These guidelines do not replace clinical judgement. Where a GP has concerns about cancer outside of the guidance, referral should still be considered.

Decision support and effective safety netting

Cancer symptoms are complex and often vague and nonspecific. 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 new symptoms develop.

Patient information on 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.

Patient information on referral for investigation

Living with and beyond cancer and end of life care

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.

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 on coping with cancer (including coping physically, emotionally, practically and talking about dying)

Information about 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 health care professionals.

Cancer emergencies

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

General information about cancer survivorship.

END OF LIFE CARE

Despite current progress, there are inevitably patients who die from their 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.

The Palliative and End of Life Care Toolkit produced by the RCGP in collaboration with Marie Curie contains a wealth of information and resources.

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 health care professionals.

If you are concerned about any symptoms, always speak to your doctor. If you have seen your doctor but your symptoms don’t go away, go back and see your doctor.

For information about signs and symptoms of cancer, go to one of the following links:

Cancer Research UK

This includes patient information about screening programmes, cancer and its treatment, and clinical trials with downloadable printable patient information leaflets on a wide variety of relevant topics, practical advice, animations and videos explaining different tests and techniques.

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 that provides up-to-date views on new developments and helps give an evidence-based perspective on common myths and misconceptions about cancer.

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.

Education

Face-to-face learning events

eLearning

Cancer Research UK offer a variety of evidence-based eLearning modules and quizzes developed in partnership with a variety of other organisations.

Modules and quizzes developed by Cancer Research UK in association with Doctors.net.uk 

RCGP cancer education hub

BMA

Audit and Quality improvement

Improving diagnosis of cancer: a toolkit for general practice

Significant event audit of all emergency presentations 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.

The RCGP, in partnership with NHS England and Macmillan, has launched an Early Diagnosis of Cancer Significant Event toolkit to support GPs in conducting high quality cancer SEAs with the aim of improving patient outcomes in the early diagnosis of cancer.

National Cancer Diagnosis Audit

The National Cancer Diagnosis Audit 2014 (NCDA) aimed to create a unique collection of primary and secondary care data, from all patients diagnosed with cancer in 2014, to allow investigation of cancer diagnosis across the whole clinical pathway, for different cancer types, across the UK.

Throughout 2016, The College, in partnership with Cancer Research UK and Macmillan, is currently running an enhancement of the previous national audit to gauge how NICE guidance has affected recognition and referrals of suspected cancer. To take part in this year's audit, please register here.

Clinical cases

Cancer Research UK with doctors.net provide the Cancer Insight Centre hub of clinical resources with the facility to discuss anonymised clinical cases submitted by others, or submit your own for discussion.

Practice profiles

The 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 data to be compared with CCG and national averages and other practices. It is a useful tool to look for areas for quality improvement.

Local Cancer Statistics

The CRUK Local Cancer Statistics pages allows GPs to find and compare statistical information and intelligence about cancer for specific areas across the UK.

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 preventive interventions as well as effective pathways for diagnosis and management.

Current policy  

Policy directions

  • England 

Achieving World Class Cancer Outcomes: a Strategy for England 2015–2020
Makes recommendations for how to improve cancer outcomes in England and includes recommendations for and relevant to primary care. 

NHS England set up the Independent Cancer Taskforce to help realise the vision of the NHS 5-Year Forward View. This document as well as NHS England’s other cancer related work can be found on the NHS England cancer web pages.

  • 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, 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

The Primary Care Cancer Toolkit will be updated on a regular basis. Please send any comments or suggestions to circ@rcgp.org.uk

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