Pancreatic Cancer

Iain Stewart Excerpts

Monday 8th September 2014 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I am grateful for the opportunity to take part in this important debate. As my hon. Friend the Member for Pudsey (Stuart Andrew) just said, it is one of the most important and enlightening debates that we have had the privilege to take part in. I pay heartfelt tribute to the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) for the huge amount of work that they have done not just to help secure this debate but across the board to promote the issue of pancreatic cancer.

One of the most important and rewarding parts of being a Member of Parliament is championing and giving voice to issues that often go unsung and ensuring that they get the attention and consideration that they deserve in Government and agencies. I echo what my hon. Friend the Member for Pudsey (Stuart Andrew) said about my hon. Friend the Member for Lancaster and Fleetwood. I know how hard it is for him to speak publicly about matters that are private and personal; the fact that he does so to champion this important issue is entirely to his credit. I am proud to call him my friend as well as my colleague. Like everyone else, I pay tribute to Maggie Watts and everyone who has worked to ensure that the e-petition was successful and that we met here to talk about it.

This debate has covered many important issues, but I will explore an aspect of early diagnosis that has been mentioned: what we can do to improve referral systems. As we have heard, that is particularly important in cases of pancreatic cancer. Some 16% of pancreatic cancer patients must visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP.

As we have heard, we need to do more to train GPs and give them effective tools to identify possible cases of pancreatic cancer, and for that matter any other type of cancer, more quickly. However, once GPs have identified cancer as a possible cause of a patient’s symptoms, that patient needs to be referred for specialist tests to rule cancer in or out definitively, and such referrals must be made quickly and as effectively as possible. The hon. Member for Scunthorpe and others have mentioned the ping-pong or tennis-ball treatment of sufferers who are referred to specialists to rule something out, then back to their GP, then back and forth until the correct diagnosis is made. As we have heard, it is often too late by then for any effective treatment.

The all-party group report concluded:

“This process of going backwards and forwards between primary and secondary care—with waits between appointments and test results—is frustrating from all perspectives. For those patients who are eventually diagnosed with pancreatic cancer, and find that they have been diagnosed at a stage too advanced for curative treatment, it is simply heartbreaking.”

We must do all that we can to break the cycle and get patients referred for specialist tests, and give them the outcomes of those tests, as soon as possible.

There are several ways in which we could help in that area. One is to ensure that robust and clear referral guidelines for pancreatic cancer are produced, helping GPs to make the right referral in the first place. Effective referral guidelines should highlight for GPs the best diagnostic routes for patients with particular symptoms and help speed up the diagnosis process, as well as making it more accurate. The guidelines need to set a low threshold at which GPs should consider sending patients on for specialist and definitive diagnostic tests if they display the symptoms of pancreatic or other types of cancer. Let us be honest: in most cases, cancer will not be the reason for a patient’s symptoms, but we should move to a system in which we seek to rule out cancer at an earlier stage.

Scotland has been mentioned a couple of times. I want to explore what is happening north of the border, although I know that everyone is preoccupied with a certain vote happening next Thursday. Healthcare Improvement Scotland is doing something potentially instructive for cancer care in the rest of the UK. It has just updated its referral guidelines for the NHS in Scotland to improve the list of symptoms that prompt GPs to consider whether to consider that a patient may have pancreatic cancer. Importantly, it has also set a low threshold at which patients presenting with particular symptoms—for example, non-responsive dyspepsia or late-onset diabetes in a weight-losing patient—should be referred for imaging scans or other diagnostic tests. That approach should be considered for the rest of the country. In her concluding speech, can the Minister tell us when NICE is planning to review its cancer referral guidelines for England and whether draft new guidelines will take note of what has happened recently in Scotland?

Faster access to imaging scans, especially for GPs, will help to make more definitive diagnoses more quickly; the hon. Member for Scunthorpe and others have raised that point. To quote again from the all-party group report, one experienced GP said:

“Presently a (hospital) doctor who has had…two years’ medical experience can request a CT scan for a patient in hospital—where I can’t.”

We should consider introducing systems that will allow GPs more direct access to scans for their patients. I know that there will be concerns in some quarters that radiology departments could become clogged up with needless referrals. However, again, looking north of the border is instructive. Scotland has made a step in that direction, and new guidelines making it easier for GPs to make direct referrals for imaging tests have been introduced. As I understand it, when the approach in Scotland was piloted, it did not lead to a clogging-up of the system, so it was rolled out more widely. Ultimately, I do not think that we should ignore the importance of treating symptoms as cancer until proven otherwise, and CT scans remain an effective way of achieving faster and more definitive diagnoses. Is the Minister prepared to consider that further for England?

The next issue is what I might term “three strikes and you’re referred”. There must, of course, be some sort of investigative threshold in place; not every patient can or should be sent for a scan. One way is to prioritise patients with particular symptoms, based on solid referral guidelines, as I mentioned earlier. However, another approach, or even a tandem approach, would be to send for a scan patients who have repeatedly turned up with the same vague symptoms a particular number of times, in order to get to the bottom of things once and for all.

I understand there have already been discussions in and around the NHS for a “three strikes and you’re referred” policy, under which if a patient visits their GP three times with the same symptom or set of symptoms that have not been resolved, they should be referred to secondary care for further investigation to get to the bottom of the problem. That is vital for pancreatic cancer, but it could also be important for other conditions that often go undetected for long periods. In my constituency this morning, I met representatives from a Huntington’s disease charity. It is an issue with that disease as well: people have the symptoms of all sorts of illness, but they are not diagnosed with Huntington’s until quite far down the line, often when earlier treatment could have been more helpful. The Department should consider such a policy, particularly for pancreatic cancer but more widely as well. Can the Minister say whether her Department is looking at introducing a cut-off point where a patient should be referred for more definitive tests, such as a CT scan?

Perhaps a more radical approach, which again is discussed in the all-party group report, is to create “one-stop shops” where patients with vague symptoms can have multiple tests carried out in one place rather than having to return to their GP after each test by a different specialist. The tests could be carried out in special dedicated centres over the course of one day or, if necessary, over several days. The key point is that this sort of multidisciplinary diagnostic clinic would speed up diagnosis, give peace of mind to patients who do not prove to have cancer and—most importantly—allow earlier treatment for those who are ultimately diagnosed with the disease. As has been said very movingly today, time is everything with pancreatic cancer patients, but too many of them are being diagnosed after emergency admission, which is too late for them to receive any form of curative treatment.

Last year’s all-party group report tells us that this cancer diagnostic centre model is already being used in countries such as Denmark and Canada. I understand that at the all-party group’s meeting last Tuesday members heard from London Cancer and London Cancer Alliance—integrated cancer systems that bring together GPs, hospitals, specialists and academics—that there are plans to test a similar model in the capital. It is hoped that this approach will not only improve patient outcomes but save the NHS money by cutting down the number of GP visits and repeat referrals, and the use of consultants’ time. A testing of this model would be a welcome step in the right direction. Can the Minister say how innovations of this kind, which are designed to improve and speed up referral pathways, can be developed and rolled out across the UK, in order to reduce the time taken to diagnose pancreatic cancer?

I conclude where I began, by saying that we need to speed up the time that it takes to diagnose pancreatic cancer; we need to stop patients being treated like ping-pong balls and being referred from a GP to a specialist, and back again, many times; we need to come up with new methods of referral that are better for clinicians and patients alike, and that will cut diagnosis times and ultimately save lives; and we need to do all this quickly, because too many people are dying far too quickly.