Patients from the most deprived populations in England are 21% less likely to be referred through the urgent suspected cancer pathway than those from more affluent areas, a recent report has warned.

Responding to the findings, the Royal Pharmaceutical Society (RPS) and the chief executive of the Company Chemists’ Association (CCA) highlighted the ‘positive role’ pharmacies could have in early diagnosis of cancer.

NHS early diagnosis targets

Current NHS targets say that by 2028, 75% of people with cancer should be diagnosed at an early stage, and they should receive a definitive cancer diagnosis within 28 days of referral.

But the Quality Watch report from the Nuffield Trust and Health Foundation warned ‘we are seriously off target’, with two in five cancer diagnoses taking place once the cancer has already advanced to a late stage.

Multiple GP visits before diagnosis

The report highlighted that on average one in five people had three or more visits to their GP before being diagnosed with cancer.

But this figure increased to one in three for people with mixed Black or Asian ethnicity.

Half of those aged 16-24 saw their GP more than three times before diagnosis and one in five of them had five or more appointments, the data showed.

In addition, people from the most deprived populations in England are 21% less likely to be referred through the urgent suspected cancer pathway than those from more affluent areas.

The report authors pointed to loss of continuity of care in general practice as one issue which makes a delay in diagnosis more likely.

Screening ‘one of most effective’ routes to early diagnosis

The report highlighted cancer screening as ‘one of the most effective ways to detect certain cancers at early stages’, although it comes with risks and is not suitable for all types of cancer.

But while NHS cancer screening programmes for breast, bowel and cervical cancers have increased the proportion of cancers referred at an early stage to 78%, efforts are needed to address inequalities in those who take up the offer and target specific groups, the report said.

‘Improving screening rates would help reduce inequalities for some cancers’, it added.

And it recommended that health systems in each area ‘work together and with deprived groups; communities of Mixed, Asian and Black ethnicities; and other vulnerable groups to understand and tackle barriers to cancer diagnosis’.

Pharmacy’s role in cancer services                     

RPS president Professor Claire Anderson told The Pharmacist that the ‘accessible health advice and patient education’ that community pharmacies provide in areas of high deprivation ‘can be key to people presenting with symptoms that they are concerned about’.

‘Using their expertise in red flags, pharmacists can then give the patient confidence to report their symptoms to their GP,’ she added.

And she highlighted possible government plans to take this further with a pilot set up last year in England for pharmacists to directly refer patients with possible signs of cancer for scans.

‘Enabling community pharmacy to be an active part of the referral pathway would benefit patients through reduced waiting times for diagnosis, which in turn leads to early treatment and improved health outcomes,’ Professor Anderson said, suggesting that community pharmacy teams could provide cancer screening services.

She also highlighted the ‘important role’ that pharmacies play in preventing some forms of cancer. ‘Community pharmacists can help patients to stop smoking and lose weight, reducing their risk of preventable cancers, as well as providing early diagnosis and self-management services for patients’, she said.

Meanwhile, Malcolm Harrison, chief executive of the CCA described the report’s findings as ‘of great concern’.

‘Pharmacists and their teams are well placed to spot the signs of cancer’, he said, adding that the CCA was ‘confident’ that the results of the pharmacy cancer referral pilot would ‘demonstrate the positive role pharmacies could have in early diagnosis’.

Mr Harrison also said that community pharmacies play ‘an integral role in providing access to primary care, especially amongst deprived areas, where healthcare need tends to be greatest’.

‘Unfortunately, since 2015, there has been a net loss of nearly 1,200 community pharmacies, and permanent closures are occurring disproportionately in the areas of higher deprivation,’ he added.

‘The sector needs new funding to protect the access it provides to patients, particularly in the most deprived areas, where healthcare need is typically greater.’

A version of this article was first published by our sister title Pulse