Doctors are being accused of letting down cancer patients by not spotting other serious medical problems caused by treatment for the disease.
GPs are failing to identify conditions such as osteoporosis, heart disease and bowel trouble that can affect patients’ lives for years after they have become free of tumours, claims one of the UK’s leading cancer experts.
The problem is so common that as many as 250,000 people who have survived cancer have had symptoms of such illnesses not picked up by their GP, Professor Jane Maher, the medical director of Macmillan Cancer Support, told the Guardian.
GPs’ lack of knowledge about cancer, and poor communication between hospital specialists and family doctors, meant signs of cancer treatment side-effects went undetected and caused patients pain, misery and discomfort, said Maher.
Research undertaken by the government’s National Cancer Survivorship Initiative (NCSI) estimates that 20%-25% of those who have been diagnosed with the disease later experience a consequence of their treatment which affects their physical or mental health or quality of life.
Given that about 2 million people in the UK have been treated for cancer, between 400,000 and 500,000 of them will have suffered a debilitating side-effect.
“GPs and oncologists are failing cancer patients far too often,” said Maher. “By not sharing vital information and recording clearly on the patients’ medical records they are putting a significant number of cancer patients at risk of having their work, health, relationships and home lives unnecessarily spoiled by long-term side-effects of their treatment.
“Based on the NCSI work looking into consequences of cancer treatment, I fear that up to 500,000 people’s symptoms are being missed by GPs.”
For example, there are about 80,000 people who have had life-saving pelvic radiotherapy for cervical, bowel, prostate or bladder cancer. while one in three of them are known to have problems as a result – with their bowels, sex life or urine function – GPs often fail to spot them, research shows.
“GPs need to recognise that people who have had cancer may have health problems related to their treatment, and GPs are the best people to pick these up,” she added. “But that doesn’t happen nearly enough at the moment.”
Maher, who is also a consultant clinical oncologist at Mount Vernon cancer hospital in London, said patients’ health suffered as a result.
She said that GPs too often do not know that an increased risk of heart disease is a potential consequence of some forms of breast cancer, so do not check patients’ blood pressure regularly.
“And while we know that men with prostate cancer have a higher risk of developing osteoporosis, that’s usually not recognised by the GP because that condition is associated with women,” she added.
“Whereas women at higher risk have a scan to check out their bones, get tablets and are advised to stop smoking and to do weight-bearing exercises, men generally don’t get that advice.
“GPs need to look at men who have had prostate cancer in a different way and be more aware of the risks of osteoporosis among them.”
However, GPs need to do much more to ensure that cancer survivors’ medical records detail the type of cancer they have had and treatment received.
“At the moment GPs aren’t recording whether someone has had chemotherapy or radiotherapy.
“That’s partly because they don’t get enough information from hospitals, but also because they don’t realise why it’s important for them to do that.”
The NHS and Macmillan are now piloting an improved treatment summary in which the oncologist spells out the treatment and risks of it.
Professor Steve Field, the chairman of the government’s advisory NHS Future Forum and ex-chair of the Royal College of GPs (RCGP), said flaws in the NHS as a whole were to blame.
“GPs will not be used to the long-term side-effects of many cancer drugs, so sometimes those side-effects aren’t picked up by the GP and primary care team,” he said.
“The quality of information given by hospitals to GPs varies and sometimes there’s confusion about who’s looking after the patient – the GP or consultant – and the patient can get lost in the cracks in the service.”
The problem was likely to get worse because of the growing number of cancer patients living longer unless the NHS as a whole, not just GPs, took action, Field added.
“There’s a strong case for there being a single electronic clinical record for every patient, something the NHS IT programme seems not to have delivered.
“There’s certainly an overwhelming desire from within the cancer community for that, and for patients to be able to put information into it, which would help the risks in the handovers of patients between hospitals and GP.
“That should improve the long-term management of patients who have had cancer.”
The government’s cancer tsar Professor Sir Mike Richards, who shares Maher’s concerns, said: “Cancer survival rates are improving year on year with more and more patients becoming long-term survivors.
“To ensure that these patients receive the best possible care it is essential that GPs and oncologists should work together as a team.”
Dr Clare Gerada, chair of the RCGP, admitted that family doctors were generally unaware of these risks.
“GPs need help with this,” she said. “But GPs are bright people who are used to managing people with long-term conditions.
“If Prof Maher and the NHS tell us exactly what cancer someone has had, and what treatment, and what the possible risks are of that, and in a way that’s easy to understand, we will do things better.”
The Department of Health said it was seeking to make healthcare more joined-up.
“The health secretary has said repeatedly, from the start of the health and social care bill, that more needs to be done to improve integration,” a spokesman said.
“Professor Maher’s comments reinforce this. Through the National Cancer Survivorship Initiative we are working to ensure that survivors get the care and support they need to lead as healthy and active a life as possible, for as long as possible.”