The same evaluation after 12 weeks of running the helpline reassured them that the idea had worked: of the 100 calls, 22 patients had concerning red flag symptoms that were brought directly into the hospital, leading to three diagnoses. The standard conversion rate for a two-week wait is four to seven per cent. “So it was really effective at finding those needles in a haystack,” says Gillis.
While they’ve slowed down the service since the end of the lockdown, they are now looking at how the idea could be developed.
Further trials are being developed across England, with Maria Caulfield, minister for patient safety and primary care, telling the Health and Social Care Committee this could be a route towards a rapid diagnosis of the disease.
However, Jeremy Hunt, who is chair of the Health and Social Care Select Committee, said instead of introducing new hotlines, the clinician who originally talks to the patient needs to listen to them instead.
Yet there is still a problem with people struggling to get face-to-face GP appointments. Analysis of NHS Digital’s GP appointment data for December 2021 shows that the number of face-to-face appointments is still significantly lower than pre-pandemic levels.
While remote consultations can be an extremely efficient way of addressing people’s problems, it doesn’t work for all people or types of illnesses. As Dr Daniel Gordon, a Doctify-reviewed NHS and private GP in London, explains: “Remote appointments don’t allow for the detailed examination and testing which can help pick up the subtle signs of early cancer. One example is skin cancer, where remote assessment using photographs often doesn’t afford the same quality as seeing the lesion in person – which in turn risks a delayed diagnosis.”
He supports the idea of nurse specialist cancer helplines being rolled out further.
“We know that with most cancers early detection is crucial in giving people the best possible chance of successful treatment. Therefore, when thinking about diagnosing cancer on a population level, it is vital that we cast as fine a net as possible.
“The addition of a cancer specialist line is another way of ensuring that fewer people slip through the net.”
There are clearly problems with the current system, where GPs are all too often the gatekeepers to being put on a cancer pathway.
In October 2021 a report published in the journal BMJ Quality & Safety found that patients with red flag cancer symptoms are being missed by GPs in more than half of cases.
The research involving almost 50,000 patients who consulted their doctor with a symptom that could be a sign of cancer pre-pandemic found six in 10 were not given an urgent referral. Of those, almost four per cent went on to develop cancer within 12 months.
Pressure on GPs not to over-refer people for tests and a lack of awareness of cancer among younger patients were cited as possible reasons for the low referral rate.
Calum Warren-Piper was 17 when he went to his GP about a lump under his armpit, only to be told that it was a skin irritation due to puberty and deodorant use. That summer he went abroad for three months and returned to his GP surgery in September, the lump still there. A different doctor picked up on the red flag that it was painless and Calum was eventually diagnosed with Hodgkin’s lymphoma, requiring six months of chemo, something, now aged 28, he still wonders if earlier detection could have avoided.
The UK has long trailed the rest of Europe in terms of cancer diagnosis. My own father was turned away twice from his GP surgery, once after being told he had flu, the second time that he should have booked a double appointment if he wanted to chat. He was eventually referred to the hospital by another doctor and diagnosed with stage 4 B-Cell lymphoma. He died 17 months later.
