Authors' objectives:

This guideline is an update of the guideline entitled Referral guidelines for suspected cancer published by the Department of Health in 2000. The new guideline takes account of new research evidence and the findings of audits undertaken since the publication of the previous guideline. The recommendations made here supersede those in the earlier guideline.

Authors' recommendations: Making a diagnosis - Diagnosis of any cancer on clinical grounds alone can be difficult. Primary healthcare professionals should be familiar with the typical presenting features of cancers, and be able to readily identify these features when patients consult with them. - Primary healthcare professionals must be alert to the possibility of cancer when confronted by unusual symptom patterns or when patients who are thought not to have cancer fail to recover as expected. In such circumstances, the primary healthcare professional should systematically review the patients history and examination, and refer urgently if cancer is a possibility. - Discussion with a specialist should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed. This may also enable the primary healthcare professional to communicate their concerns and a sense of urgency to secondary healthcare professionals when symptoms are not classical. - Cancer is uncommon in children, and its detection can present particular difficulties. Primary healthcare professionals should recognise that parents are usually the best observers of their children, and should listen carefully to their concerns. Primary healthcare professionals should also be willing to reassess the initial diagnosis or to seek a second opinion from a colleague if a child fails to recover as expected. Investigations - In patients with features typical of cancer, investigations in primary care should not be allowed to delay referral. In patients with less typical symptoms and signs that might, nevertheless, be due to cancer, investigations may be necessary but should be undertaken urgently to avoid delay. If specific investigations are not readily available locally, an urgent specialist referral should be made. The need for support and information - When referring a patient with suspected cancer to a specialist service, primary healthcare professionals should assess the patients need for continuing support while waiting for their referral appointment. The information given to patients, family and/or carers as considered appropriate by the primary healthcare professional should cover, among other issues: - where patients are being referred to - how long they will have to wait for the appointment - how to obtain further information about the type of cancer suspected or help prior to the specialist appointment - who they will be seen by - what to expect from the service the patient will be attending - what type of tests will be carried out, and what will happen during diagnostic procedures - how long it will take to get a diagnosis or test results - whether they can take someone with them to the appointment - other sources of support, including those for minority groups. - The primary healthcare professional should be aware that some patients find being referred for suspected cancer particularly difficult because of their personal circumstances, such as age, family or work responsibilities, isolation, or other health or social issues. - Primary healthcare professionals should provide culturally appropriate care, recognising the potential for different cultural meanings associated with the possibility of cancer, the relative importance of family decision-making and possible unfamiliarity with the concept of support outside the family. Continuing education for healthcare professionals - Primary healthcare professionals should take part in education, peer review and other activities to improve or maintain their clinical consulting, reasoning and diagnostic skills, in order to identify, at an early stage, patients who may have cancer, and to communicate the possibility of cancer to the patient. Current advice on communicating with patients and/or their carers and breaking bad news1 should be followed.

Authors' methods: Clinical guideline

Project Status: Completed

URL for project: http://www.nice.org.uk/page.aspx?o=261649

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)