Pancreatic Cancer Action has been campaigning for pharmacists to assess cancer symptoms and refer patients to specialists for over a decade. It was included in our 2015 Manifesto, and more recently we included it in our submission to the NHS Tumor site review and the new 10-year cancer strategy submission.
Working with the Transformation Lead for NHS Cancer Programme we developed proposals of what a system of cancer referrals would look like for pharmacists. This included developing a decision tree that would be adapted into clinical guidance to support pharmacists in detecting pancreatic cancer.
We are also supporting NHS England to review what education and support Pharmacists will need to carry out these new roles and have as of two weeks ago provided the NHS Cancer Board with a background with all the work we currently do.
Ade Williams MBE, lead pharmacist, Bedminster Pharmacy, said: ‘This development is very positive and welcome. As someone who has campaigned for this, I am indebted to Ali Stunt and the Pancreatic Cancer Action team who have invested a lot of resources and time, encouraging and equipping community pharmacy teams for their role before many of us even though it was necessary or possible.’
‘It is now more important than ever that any delivery design delivers the vision, scalability and sustainable model required. With pancreatic cancer, this will be especially important for early diagnosis.’
Currently, a patient would present at a pharmacy with red flag cancer symptoms and all the Pharmacist can do is make an informal referral to a GP. In reality, this is nothing more than a suggestion; a suggestion which is ignored by those who have vague symptoms; such as those which are signs of pancreatic cancer.
We were delighted that earlier this year NHS England announced that they would pilot this referral scheme in two cancer alliance areas. Now it appears this will be a national role out.
In order to improve the early diagnosis of pancreatic cancer and save lives, pharmacies need the power to assess patients and refer those with red flag symptoms directly to the hospital without the need to see their GP. Seeing a highly qualified pharmacist for minor illness, assessment or cancer screening, could result in faster referral and diagnosis of cancer as well as freeing up GP time.
The majority of the country lives within a 20-minute walk of their nearest pharmacy and 95% of the population uses their pharmacy at least once a year. Local pharmacies are accessible and well placed within communities. Patients visiting their pharmacy frequently or with red flag symptoms, who may not otherwise go to their GP may benefit from the plan.
Pilot studies, where pharmacists referred patients to their GP or directly for screening or diagnostics have been successful in the case of lung and bowel cancer.
A pilot study of 33 pharmacies in Northern England found that a common pancreatic cancer symptom, unresolved indigestion, was the second most common cancer symptom that pharmacists referred for.
‘For a long time, I have held the belief that community pharmacists can play an integral role in assisting in the diagnosis of cancer, and in particular pancreatic cancer. This is why we, at Pancreatic Cancer Action, developed e-learning and other materials to support pharmacists to identify patients with worrying symptoms.’
‘We have also lobbied for pharmacists to be able to directly refer patients with symptoms of cancer and I am delighted to hear that soon, they will be able to do so. However, there are major problems with diagnostic capacity and workforce vacancies creating backlogs of referrals currently. So, to support this initiative, not only will pharmacists require the necessary training and funding but that the system they are referring to needs to be fit for purpose,’ Ali Stunt, founder and CEO of Pancreatic Cancer Action.
Pharmacist having the ability to make direct referrals has the potential to save thousands of lives each year by supporting patients to get that diagnosis of cancer earlier and in time with full life-saving treatments. Despite this real and positive progress, there is still some concern that they will not be the diagnostic capacity to deal with the number of referrals made by our highly qualified pharmacist community.
Direct referrals for cancer referrals will not have a significant impact on survival rates if the infrastructure (equipment and associated workforce) is not there to get the diagnosis. There is already an issue that those suspected to have pancreatic cancer have to wait a considerable length of time to get a test. Pre-pandemic the waiting lists were at an all-time high and the problem has only gotten worse.
An International Cancer Benchmarking Partnership (ICBP), study explored stakeholders’ perceptions of the role of health system capacity necessary for cancer care in influencing cancer survival in 7 high-income countries. They identified 3 key themes important in shaping cancer outcomes:
- Primary care and access to diagnostic evaluation
- Specialist care and access to treatment
- A workforce pertaining to diagnostic and treatment phases.
Each nation which has improved its infrastructure for cancer diagnosis and treatment has improved cancer outcomes. Countries with higher survival rates for pancreatic cancer have significantly more Radiologists and Radiographers and they also have substantially more CT scanners per capita.
CT scans are often used to diagnose pancreatic cancer because they can show the pancreas clearly with a sensitivity of over 90%. They can also help show if cancer has spread to organs near the pancreas.
A CT scan can also help determine what stage the cancer is at and if surgery might be a treatment option. When looking at the number of CT scanners per capita in comparable nations the UK is 35th out of the 38 OCED (Organisation for Economic Co-operation and Development) countries.
The UK has an estimated 4.8 consultant radiologists per 100,000 people. This is one of the lowest in all of Europe, the average for Western Europe is 12 radiologists per 100,000 population.