Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by jchoules
25 April 2019
We know that about 10,000 UK cancer deaths a year would not occur if the UK performed as well as its European counterparts in diagnosing cancer early. Much of the problem lies in General Practice – it’s very difficult to identify the patient who may have a cancer explaining their symptoms. There has been a lot of important work conducted by Prof Willie Hamilton and his colleagues who have identified which symptoms of possible cancer actually matter. These studies have led to the development of Risk Assessment Tools (generally abbreviated to RATs). The RATs tell GPs what the patients’ risk of having a possible cancer is and is reported as a percentage. This figure can be calculated for single symptoms (e.g. the risk of cancer of the lung with coughing blood is 2.4%), as pairs of symptoms (coughing blood accompanied by loss of weight is 9.2%) or as repeated symptoms (a re-attendance with coughing blood is 17%). RATs have been developed for 18 different types of cancer and have been given to all UK GPs practices in either paper, mouse mat, calendar, or web-based forms. RATs are useful but are perhaps not immediately accessible to GPs – a GP needs to be thinking about possible cancer and needs to have to the tools to hand to see what a patient’s risk of cancer is.
Recognising this problem, RATs have subsequently evolved. In partnership with Macmillan, the UK cancer charity, electronic versions for seven major cancers (lung, colorectal, pancreas, oesophago-gastric, bladder, kidney and ovarian) have been developed. These eRATs will be integrated into GPs’ clinical software. Using information in patient’s medical records the eRATs automatically prompt the GP when the risk of one or more of these cancers is above 2%. This is an important improvement on the RATs – GPs will be alerted to the small possibility of cancer when they perhaps were not considering it.
The big question that we need to ask ourselves is do these eRATs work? Will they help us catch cancer sooner? Here, in Exeter, led by Prof Willie Hamilton, our team of experts in cancer diagnostics, general practice, health economics, and many other areas are trying to answer this important question. We will do this via a large trial, a trial we are calling ERICA.
We are looking to recruit 530 practices across England. Half of the practices will be given access to the eRATs and half will not. Practices will be in the trial for about 2 years and out of all the patients diagnosed with cancer during this time we will be looking at the stage of the cancer that they are diagnosed with (early vs. late stage). If the eRATs help GPs we might expect to see an increase in early (vs late) cancer stage diagnosis for patients from practices who used the eRATs compared to the practices who did not use them. The study will also explore other important issues such as how the eRATs impact on patients’ and GPs’ experience of care. We will also look at how the eRATs impact NHS costs and the downstream consequences on NHS services.
This trial represents a significant piece of work – it will be the largest trial of cancer diagnostics in general practice in the UK. This trial has only been made possible via a very generous donation of £2m from the Dennis & Mireille Gillings Foundation. It is also being financially supported by Exeter University and Cancer Research UK.
Oh, and my job? I’m responsible for ensuring that we get the trial done on time and within budget. It’s going to be a fantastic challenge and I’m relishing the prospect of supporting our wonderful team to deliver this vital piece of research. We start recruiting practices in summer 2019. Although we won’t have definitive findings until autumn 2023, please do come back to me to get an update on how we’re doing…
Raff Calitri, ERICA Trial Manager