Prostate cancer update

Referrals and treatments for prostate cancer have dropped significantly over the past two years. Across England 14,000 fewer men have begun treatment for prostate cancer than would have been expected pre-pandemic.

Wessex Cancer Alliance are supporting a range of projects to increase awareness, particularly among higher risk groups:

Community Awareness Raising

• Working with Wessex Voices and Dorset Race Equality Council to raise awareness of the heightened risk of prostate cancer in black men.
• To mark World Cancer Day (Friday 4 February 2022) we hosted a webinar, Let’s Talk About Prostate Cancer. The webinar, FAQ document and further information are available here.

Targeted Prostate Health Checks

• Pilot case-finding project in Southampton that invited black men over 45 to complete a urinary symptom questionnaire and get their PSA checked. The Cancer Alliance are aiming to roll this out more widely later in the year.

Prostate Health Test at UHS

• Southampton patients can access the Prostate Health Test. Men can self-refer to UHS by emailing prostatehealthtest@uhs.nhs.uk (or phone 07881 230620) where they will receive an automated response with information and a prostate cancer risk assessment questionnaire.

Supporting National Campaigns and Local Initiatives

• We are supporting Prostate Cancer UK and NHS England’s campaign to find the men who have not started treatment for prostate cancer due to the pandemic. Share their thirty-second risk checker with patients, friends and family.
• The charity Prostate Cancer Support Organisation (PCaSO) is working across Hampshire and Dorset to provide PSA testing at organised events. For more information please visit the PCaSO website

For more information on PSA testing, consider the short Gateway C Course Responding to a PSA Screening Request.

Bowel Cancer Awareness Month

April is Bowel Cancer Awareness Month. Consider sharing some messages with patients on your website or through social media to raise awareness. Bowel Cancer UK have created a comms toolkit to help.

• Every 15 minutes somebody is diagnosed with bowel cancer in the UK, that’s nearly 43,000 people each year. It’s the fourth most common cancer.
• It is the second biggest cancer killer in the UK accounting for around 16,600 deaths every year.
  
• 94% of bowel cancer is diagnosed in patients over the age of 50 but annually more than 2,600 patients under 50 years are diagnosed.
• 54% of bowel cancer is preventable due to eating processed meat, obesity, alcohol consumption, smoking and too little dietary fibre.
• When diagnosed at the earliest stage, more than 90% people with bowel cancer will survive their disease for five years or more, but this drops significantly as the disease progresses. Early diagnosis really does save lives.

See more Cancer Research UK bowel cancer statistics

What can we do?

1. Prevention – Educate patients about cancer risks and lifestyle choices opportunistically when undertaking long term condition reviews, when discussing weight issues, and proactively with waiting room campaigns. See more on bowel cancer risk factors.

2. Screening – Encourage patients to take part in the national bowel screening programme (aged 56 to 74 yrs every 2 years). Consider proactive follow up of non-attenders (our bowel screening QI toolkit provides ideas for how to do this)

3. Earlier diagnosis of symptomatic patients - Symptomatic FIT testing enables earlier diagnosis of patients with vague symptoms - the so-called NICE DG30 patients who are aged 50 years or older with either abdominal pain or weight loss OR aged <60 years with either a change in bowel habit or iron deficiency anaemia OR aged > 60years with anaemia in the absence of iron deficiency.

For more information on the use of FIT please see the Gateway C FIT module.

Remember the threshold for a positive FIT test is 120 ug for bowel screening and 10 ug when ordered by a GP (3 in some parts of Wessex). Don’t be over reassured by a negative screening test in a symptomatic patient.

4. Faster Diagnosis - Broadly the greater the FIT test result, the greater the risk of bowel cancer.

This is why it is so important to request a FIT test when making a 2 week wait colorectal referral even in rectal bleeding. Secondary care use this information to ensure patients at highest risk are investigated most rapidly. In 2022/23 practices are being incentivised to do this. It’s also very important that the patient understands the importance of completing the test rapidly and knows how to do the test - see the Cancer Research UK patient information leaflet on FIT .

Breast pain

Breast pain is a very common symptom affecting 2 out of 3 women at some stage with 1 in 10 experiencing moderate to severe symptoms. Many women present to their GP and are commonly very anxious about breast cancer. Around the country, breast pain is one of the most common reasons for referral to a hospital breast clinic. However breast pain as a sole symptom is not associated with breast cancer.

As GPs we are well placed to assess and reassure our patients. Gateway C has produced a really useful infographic to help us assess these patients systematically and enable us to reassure a number of patients without the need for referral to secondary care. This brief video discusses this further. If symptoms have not settled in 3 months, non urgent referral may be needed. Providing information about breast pain to our patients is helpful. 

Macmillan Support Line

A great resource to support our patients living with cancer

Macmillan offers support to cancer patients who may experience significant problems emotionally, physically, socially and financially. As clinicians we can now refer directly to this support via a referral form on SystmOne and EMIS. Patients can self refer via phone on 0808 808 0000. Further information can be found on the Macmillan website. 

This may be useful to share with patients during cancer care reviews and with other members of the practice team e.g. social prescribers.

Cancer Care Co-ordinators Survey

Wessex Cancer Alliance are looking at ways to support & incentivise practices and PCNs to recruit cancer care co-ordinators as part of the additional roles and reimbursement scheme (ARRS) for the forthcoming year.

We would be grateful if Practice Managers, Clinical Directors or PCN managers could complete this brief survey so we know how to best support PCNs moving forward with their recruitment of cancer care co-ordinators.

Please click here to complete the survey. The closing date is 30th April 2022.