In 2007, the School supported the MoleMate trial, led by Dr Fiona Walter and the Cancer Group at the Primary Care Unit in Cambridge. The trial explored the management of the serious skin cancer melanoma in primary care, showing that a novel diagnostic aid was no more effective in improving the management of suspicious pigmented lesions than the routine application of an existing checklist, as recommended by NICE guidelines. Findings from the MoleMate trial were used to develop Dr Walter’s NIHR Clinician Scientist award, funding the MelaTools studies, which investigates ways to help patients and GPs diagnose melanoma earlier.
The DISCOVERY programme – collaborations and further research funding
Cross-School collaborations - resulted in 5 institutions and a Primary Care Trust and led to a NIHR programme award in 2010. The research aimed to optimise the diagnosis of symptomatic cancer in primary care (PI Hamilton, Exeter; deputy PI Walter, Cambridge).
The DISCOVERY programme’s influential set of cross-institutional national and international research studies set out to explore, test and describe new or improved ways to help GPs and primary care teams detect cancer early in primary care. The programme has delivered more than 24 publications in high-impact journals and three completed PhDs to date, and would not have been possible without School support.
- The CAPER studies identified symptom risk profiles for a number of cancers, including kidney, bladder, prostate, breast, uterus, ovary, oesophageal-gastric, pancreas, lymphoma, leukaemia
- The SYMPTOM studies collected prospective data from patients as they were referred with symptoms suspicious of lung, colorectal and pancreatic cancer, as well as data from GP and hospital records. These studies highlight that healthcare professionals in both primary and specialist care should have an increased awareness of the risk of cancer among people with comorbid conditions, and highlight the risk of mis-attributing potential cancer symptoms in those with mental health problems
- The PIVOT studies identified patient preferences for, and experiences of, referral for investigation for cancer symptoms.
Impact on public awareness
Findings from these research programmes have informed national public awareness campaigns and media discussion about reducing the patient interval by encouraging appropriate help-seeking for suspicious symptoms. The Cambridge study was used in some of the ‘Be Clear on Cancer campaigns’, launched in 2011 by the Department of Health and which is still ongoing in 2017.
Impact on clinical practice
Overall, these research programmes have raised awareness amongst GPs of cancer diagnostics through publishing and discussion in the press and high impact journals.
Programme findings were cited as underpinning evidence for guidance from NICE in 2015 in NG12. Individual studies have informed specific areas of activity: for example, the DISCOVERY programme’s CAPER studies provided information on the risk for each symptom on its own and each combination of cancer symptoms. Summary information was provided directly to GPs in easy access formats.
Impact on commissioners and policy-makers
Early evidence suggests that Risk Assessment Tools can be applied to improve referral rates, conversion rates and detection rates in colorectal cancer. The PIVOT studies showed that patients clearly want testing at a lower threshold than is current in the NHS. Evidence was submitted to inform the revision of NICE Guidance NG12 and to inform international cancer diagnostic guidelines and diagnostic pathways.
Impact on this field of research:
Taken together, these research studies have helped to drive a national ambition to achieve earlier cancer diagnosis, which in turn, is driving up investment in research on diagnostics in primary care. The first CRUK Catalyst award, made to the international CanTest Collaborative in 2016, led from Cambridge, will increase the capacity and sustainability of cancer detection research and provide for the first International School for Cancer Detection Research in Primary Care.