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Study: Targeted letters to patients at risk of cancer ‘significantly’ increase clinical investigations

by Awil Mohamoud
11 December 2020

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Targeted initiatives encouraging patients deemed at risk of cancer to book a GP appointment lead to ‘significantly’ more investigations and examinations and higher referrals, a study published in the British Journal of General Practice(BJGP) has found.

The research involved sending a GP-signed intervention letter to approximately half of 1,513 patients from 24 practices, all of whom who had not consulted their GP in the previous 12 months and were identified as having at least two risk factors for late presentation of cancer.

Patients who received the letter ended up having a significantly higher number of consultations than those in the comparison group (436 compared to 335) over the seven months, the study found, but there was no increase in the number of people actually consulting.

The researchers said this finding demonstrated that ‘a targeted primary care-based intervention can change consulting behaviour in this population, but not necessarily in the way expected’. 

Targeted patients also had twice as many consultations for six symptoms potentially suspicious for cancer, which had been explained in the leaflet sent to them. 

Investigations and examinations

The study also found that more clinical investigations and physical examinations were carried out among patients who received the letter following their consultations, with 282 compared to 212 in the comparison group. The rate of onward referrals was also higher for these patients, but not by a significant amount, it added. 

The report said: ‘Irrespective of the symptom(s) patients presented with, if the increase in consultation rates observed among the target patient group in this trial were to be sustained, this may result in earlier diagnoses of cancer. 

‘This is because GPs generally enquire about ‘red flag’ symptoms when patients present with other lower-risk possible cancer symptoms. Increased consultation rates also provide GPs with an opportunity to promote primary and secondary prevention of cancer and other diseases by supporting patients to attend non-symptomatic screening.’

The letter

GPs identified patients from their records who were aged 50-84, and who had not had an appointment at their practice for at least 12 months, to participate in the study. 

They then restricted eligibility to the intervention letter to those who, if they developed cancer, were at increased risk of being diagnosed at a later stage, the report said. 

This included those living in poverty, with chronic comorbidities, smokers, certain ethnic groups, and people who previously missed screenings or tend to use emergency services rather than primary care. 

The letter highlighted potential signs of cancer and advised patients that they should consult with their GP for any symptoms, while also reassuring them that ‘this would not be considered wasting the doctor’s time’, the report said.