Five steps to getting cancer diagnostics back on track

This report published by Cancer Research UK outlines the current state of play on diagnostics in England and how we can address issues to deliver a world-class cancer service. 

A new report highlights five things a post-election UK Government could do to get cancer diagnostics back on track:

• Reform of the UK Government’s approach to investment in health
• Improve workforce planning for diagnostic services 
• Setting up screening programmes for success
• Prepare the health system for the adoption of innovation
• Take a strategic approach to diagnostics

Further detail: Five steps to getting cancer diagnostics back on track

Full report: A full diagnostic: Cancer Research UK’s position on diagnostic services and cancer in England

Is cancer diagnosis veering off course?

Nuffield Trust – April 2024

There were nearly 330,000 new cancer diagnoses in England in 2021 – that’s more than 900 people a day finding out that they have a disease which is one of the most common causes of death in England.

Further information – Is cancer diagnosis veering off course?

Implementing a timed HPB cancer diagnostic pathway

NHS England – 25th March 2024

Best practice timed pathways support the ongoing improvement effort to shorten diagnosis pathways, reduce variation, improve experience of care, and meet the Faster Diagnosis Standard (FDS).

The 28-day Faster Diagnosis Standard remains the single standard by which the speed of diagnosis of cancer will be measured under Cancer Waiting Times. However, some types of cancer are particularly aggressive, and particular effort should be made to diagnose them even faster than the headline target. Many hepato-pancreatic biliary (HPB) cancers fall into this category, and the pathways in this document, which set out the sequence of events that would be required to complete the diagnostic process wherever possible within 21 days are reflective of that.

This HPB pathway is part of a series, which includes the oesophago-gastric pathway and completes the pathways that cover upper gastrointestinal cancers, published since April 2018.

Implementing a timed HPB cancer diagnostic pathway

Implementing a timed HPB cancer diagnostic pathway – audit tool

Urgent GP direct access to diagnostic services for people with symptoms not meeting the threshold for an urgent suspected cancer referral

NHS England – September 2023

This guidance is not a clinical guideline.

It provides advice on the use of urgent direct access referrals to specific diagnostic tests where the threshold for referral under the urgent suspected cancer referral pathway – to a specialist or for urgent GP direct access testing – as outlined by National Institute for Health and Care Excellence guideline NG12 is not met.

This guidance is distinct from NG12 but should be considered alongside it.

Urgent GP direct access to diagnostic services for people with symptoms not meeting the threshold for an urgent suspected cancer referral

Cancer Research UK : More than 65,000 people are left waiting to find out if it’s cancer each month

Cancer Research UK | May 2022 | More than 65,000 people are left waiting to find out if it’s cancer each month

New calculations from Cancer Research UK estimate that, on average, over 65,000 people in England are left waiting longer than 28 days to find out whether they have cancer each month.

These estimates are based on the latest data from the Faster Diagnosis Standard (FDS). The FDS is a performance standard introduced by Government in 2021. It’s used to better capture how long people on certain cancer-related referrals wait for a diagnosis.

This applies to people referred by their GP urgently with suspected cancer, following breast symptoms, or have been picked up through cancer screening.

The current FDS target is set at 75 per cent, meaning three quarters of people being urgently referred should be told they have cancer or given the all-clear within that timeframe. However, this target has yet to be met.

Calculated as the average number of people who received a diagnosis, or had cancer ruled out and the result communicated to them beyond the 28-day standard between October 2021 and February 2022, this leaves approximately 65,400 people in limbo.

Full details are available from CRUK

NHS England: A record year for people receiving lifesaving NHS cancer checks

Almost three million people were referred for cancer checks over the last 12 months – the highest year on record – up by over a tenth on the 2.4 million people referred before the pandemic.

NHS cancer chiefs continue to urge people to come forward as the latest data shows that record numbers of people have received vital NHS cancer tests in the last year (March 2021 – February 2022).

Despite pressures on hospitals due to Covid-19, the number of people being treated for the disease remained higher than before the pandemic – with 315,000 starting treatment b compared to 313,000 before the pandemic.

In order to meet increasing demand for cancer checks, NHS services across the country are expanding their diagnostic capabilities through one stop shops for tests, mobile clinics and cancer symptom hotlines, ensuring people are diagnosed and treated as early as possible to give them a much better chance of beating the disease.

At The Rotherham NHS Foundation Trust, they have introduced telephone triage for certain cancer referrals so that patients can speak to doctors sooner, as well as increasing the use of ‘straight-to-test’ pathways for lower gastrointestinal patients to get diagnosed as early as possible, and expanding one-stop-shop slots for patients referred under a breast cancer pathway, so patients can get all their tests in one trip.

In Merseyside, a grandmother of three has become the first person in the region to receive life-changing hip replacement surgery and go home safely in the same day.

Liverpool University Hospitals NHS Foundation is now rolling out this brand-new day case procedure to more patients, helping to reduce waiting lists for orthopaedic treatments and allowing people to recover in the comfort of their own homes.

In Buckinghamshire, a new mobile cataract suite on the grounds of Stoke Mandeville Hospital enables the Trust to perform 80-100 additional cataract surgeries each week.

Staff in Mid Yorkshire Hospitals NHS Trust have used additional NHS England funding to make improvements to see and treat more people, including converting one large open plan room into three new rooms which means oral and maxillofacial patients can be seen, diagnosed and treated on the same day, cutting back the number of visits patients need to make to see specialists.

A new theatre for minor operations means 40 patients each week can be moved out of main theatres, enabling more complex inpatient operating such as hip and knee replacements, to take place in the main theatres at Pinderfields Hospital, while laminar flow systems in two theatres at the Trust will double the rate of orthopaedic operations available.

More than 30,000 people every month are being invited for lung cancer checks through NHS mobile trucks visiting at risk communities across the country, as part of the biggest programme to improve early lung cancer diagnosis in health service history.

News release available in full from NHS England

Artificial intelligence and cancer diagnosis: caution needed

Venkatesan, P. | 2021| Artificial intelligence and cancer diagnosis: caution needed | The Lancet Oncology | DOI: https://doi.org/10.1016/S1470-2045(21)00533-7

The use of artificial intelligence (AI; computer-based algorithms that mimic human cognition) offers the promise to transform clinical medicine and health care in the near future. The concept of using machines to complement or replace human workers and decrease workloads is an attractive one, particularly now when the COVID-19 pandemic has greatly increased the global burden of health care and created a backlog in the care of other conditions, including in the oncology setting.

Contact the Library & Knowledge Service for a copy of this article

A quarter of cancer patients experience avoidable delay to diagnosis

One in four cancer patients experienced a delay to their diagnosis that could have been avoided, according to a new study | via Cancer Research UK

A new study, published in Cancer Epidemiology, looked at data the national cancer registry of around 14,300 people diagnosed with cancer in England in one year.

It found that nearly 3,400 patients experienced a delay that could have been avoided. Half of these patients waited around two months longer to be diagnosed compared with those who didn’t have an avoidable delay.

The reasons for delays are complex but researchers on this study attempted to identify what could go wrong. The study authors asked GPs to identify when the delay happened – before the patient saw their GP, while they were still being assessed by the GP practice or after they had referred them.

The data showed 13% of all avoidable delays happened before the patient saw their GP and 38% after the GP referred them to hospital. The other half (49%) happened while the patient was being assessed by the GP surgery including waiting for tests to be done and results to be sent back.

Full story at Cancer Research UK

Research article: Swann et al. | The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients | Cancer Epidemiology | published online 3 December 2019.

78 NHS trusts to receive new cancer screening machines

78 trusts will receive funding for new machines that will improve patient experience and lead to earlier diagnosis | via Department of Health and Social Care

The Rotherham NHS Foundation Trust is one of 78 trusts that will benefit from funding for new cancer testing and detection technology.  The new machines will improve screening and early diagnosis of cancer, and are part of the government’s commitment to ensure 55,000 more people survive cancer each year.

Last month the Prime Minister announced the extra £200 million in funding for new cancer screening equipment. 78 trusts will receive funding over the next 2 years to replace, refurbish and upgrade:

• CT and MRI scanners – bringing in alternatives with lower radiation levels
• breast screening imaging and assessment equipment

Replacing and upgrading machines will improve efficiency by:

• making them easier to use
• being quicker to scan and construct images
• reducing the need to re-scan

This new equipment also brings new capability, with many machines enabled for artificial intelligence (AI) so the NHS is ready for the challenges of the future.

Each trust has been allocated funding for new machines based on an assessment of local infrastructure and local population need. They will all contribute to the NHS Long Term Plan’s goal of catching three-quarters of all cancers earlier when they are easier to treat.

Full story at Department of Health and Social Care

See also: Full list of trusts that will receive funding.

Ultrasound breakthrough can pinpoint cancer with precision

Heriot Watt University | September 2019 | Ultrasound breakthrough can pinpoint cancer with precision

Experts at Heriot Watt University have found a new technique which uses super-resolution ultrasound methods that improves resolution of ultrasound images by 5-10 times compared to standard current ultrasound images.

Their innovation allows whole organs to be scanned in super-resolution for the first time which, it is anticipated, will lead to earlier cancer diagnoses and allow medical staff to more effectively target treatments to any malignant tissue. Potentially, it could eventually replace the need for biopsy altogether.

The team behind this innovation  the aim is to start human trials using the new technique in three months’ time at the Western General Hospital in Edinburgh. Patients with prostate issues will be the first to benefit from the enhanced imaging.

Professor Alan McNeill, Consultant Urological Surgeon at the Western General Hospital in Edinburgh said: “Prostate cancer is an increasing problem for our society. Whilst we have a number of methods for detecting it, these don’t always provide us with the important information that we need regarding who has cancer that needs to be treated and who doesn’t.

“A method that maps the blood flow of the tumour accurately could well provide new information about the disease state that allows us to better identify those men who need urgent treatment and those who don’t. It is exciting that we will be the first hospital in the world that will assess this method with patients.” (Source: Heriot Watt University)

Read the full, unabridged press release from Heriot Watt University

Abstract

Objectives The aim of this study was to provide an ultrasound-based super-resolution methodology that can be implemented using clinical 2-dimensional ultrasound equipment and standard contrast-enhanced ultrasound modes. In addition, the aim is to achieve this for true-to-life patient imaging conditions, including realistic examination times of a few minutes and adequate image penetration depths that can be used to scan entire organs without sacrificing current super-resolution ultrasound imaging performance.

Methods Standard contrast-enhanced ultrasound was used along with bolus or infusion injections of SonoVue (Bracco, Geneva, Switzerland) microbubble (MB) suspensions. An image analysis methodology, translated from light microscopy algorithms, was developed for use with ultrasound contrast imaging video data. New features that are tailored for ultrasound contrast image data were developed for MB detection and segmentation, so that the algorithm can deal with single and overlapping MBs. The method was tested initially on synthetic data, then with a simple microvessel phantom, and then with in vivo ultrasound contrast video loops from sheep ovaries. Tracks detailing the vascular structure and corresponding velocity map of the sheep ovary were reconstructed. Images acquired from light microscopy, optical projection tomography, and optical coherence tomography were compared with the vasculature network that was revealed in the ultrasound contrast data. The final method was applied to clinical prostate data as a proof of principle.

Results Features of the ovary identified in optical modalities mentioned previously were also identified in the ultrasound super-resolution density maps. Follicular areas, follicle wall, vessel diameter, and tissue dimensions were very similar. An approximately 8.5-fold resolution gain was demonstrated in vessel width, as vessels of width down to 60 μm were detected and verified (λ = 514 μm). Best agreement was found between ultrasound measurements and optical coherence tomography with 10% difference in the measured vessel widths, whereas ex vivo microscopy measurements were significantly lower by 43% on average. The results were mostly achieved using video loops of under 2-minute duration that included respiratory motion. A feasibility study on a human prostate showed good agreement between density and velocity ultrasound maps with the histological evaluation of the location of a tumor.

Conclusions The feasibility of a 2-dimensional contrast-enhanced ultrasound-based super-resolution method was demonstrated using in vitro, synthetic and in vivo animal data. The method reduces the examination times to a few minutes using state-of-the-art ultrasound equipment and can provide super-resolution maps for an entire prostate with similar resolution to that achieved in other studies.

The original research is available in full from Investigative Radiology

In the news:

BBC News Ultrasound breakthrough ‘can spot cancer earlier’