Advocating for patients through laboratory tests: what do GPs’ use of blood tests for suspected cancer tell us?

[摘要] In this issue of the BJGP, Ben Cranfield and colleagues describe the frequency with which common blood tests were ordered by GPs prior to their patients receiving a diagnosis of cancer.1 Data from the National Cancer Diagnosis Audit (NCDA) provided a nationally representative selection of patients in England diagnosed with cancer in 2018, and included detailed data collected from GP records. The NCDA provided information not only on the types of blood tests, but also patients’ symptoms and the time course to obtain a diagnosis.MAIN FINDINGS Of the 39 752 patients included in the audit, less than half (41%) had blood tests done prior to diagnosis. Use of blood tests varied greatly depending on type of cancer. For example, patients with leukaemia (84%), myeloma (76%), or pancreatic cancers (71%) were far more likely to have blood tests than those with vulval cancer (8%), breast cancer (4%), or melanoma (2%). This provides strong evidence that GPs were judiciously considering the most appropriate diagnostic test for their patient with suspected (but at this point still undiagnosed) cancer. A greater proportion of patients presented with non-alarm (non-specific) symptoms (n = 16 487, 41%) than alarm symptoms (n = 13 778, 35%), as defined by the National Institute for Health and Care Excellence (NICE). Moreover, blood tests were nearly three times more likely to be used in those with non-alarm symptoms than those with alarm symptoms.These findings also provide interesting insights into daily practice constraints GPs experience and their decision-making processes around patients with suspected cancer. Blood tests are clearly used as adjuncts to initial clinical assessment to provide some diagnostic clarity, as demonstrated by nearly half of the patients who presented with non-alarm symptoms. Laboratory tests may also have helped GPs justify referral under the ‘rapid 2-week wait’ or other diagnostic pathways, particularly for those patients who may not have fully met referral criteria.

[学科分类] 卫生学