Higher cancer survival in Australia linked to GP willingness in referring patients for tests

Thursday 28 May, 2015

GPs in Victoria and New South Wales are more likely to immediately refer people with possible cancer for tests or to a specialist than those in comparable countries, according to new research published in BMJ Open* today (Thursday).

The research shows a link between a country’s cancer survival and how likely that country’s GPs were to refer patients immediately. Australian GPs were consistently among the most likely to refer quickly.

Earlier research from the International Cancer Benchmarking Partnership (ICBP) has shown cancer survival is highest in Australia, Canada and Sweden; intermediate in Norway; and lower in Denmark, England, Northern Ireland and Wales.

The latest research under ICBP - a collaboration between six countries with similar health care systems, which in Victoria is funded by Cancer Council Victoria and the Department of Health and Human Services - reveals striking new evidence for a possible explanation of these international survival differences.

Researchers, including some from the University of Melbourne, analysed survey responses from 2795 GPs on how they would manage different scenarios of patients coming to them with possible cases of either lung, colorectal or ovarian cancer. These were then mapped against survival data for those countries.

GPs were then asked a series of questions including what access they had to specific tests, waiting times for tests and results and whether they could speak to cancer specialists for advice. Almost every GP in Victoria reported direct access to blood tests, X-rays and ultrasound for possible cancer diagnosis (99 per cent) – higher than any other jurisdiction.

Similarly, almost every GP in Victoria and New South Wales reported having direct access to CT and MRI scans – at least twice the level of direct access their peers in other countries reported having **.

GPs in Australia also reported dramatically shorter waiting times for the results of CT, MRI and ultrasound scans compared to all other countries (with a total waiting time of around one and a half weeks). In comparison, Northern Ireland had the longest waiting times for tests and results of ultrasound and CT scans (of around seven to eight weeks for each).

Cancer Council Victoria CEO Todd Harper said: “On the official date of Australia’s Biggest Morning Tea I think we should be celebrating the improvement we have seen in overall cancer survival in this state and this country, and the role that GPs play in this.

“A health system that allows GPs to refer people when and if they suspect cancer is vital to ensure early diagnosis and access to the best treatments. Cancer Council is working with GPs as well as state and national decision makers to provide data, resources and training so that GPs refer the right patients at the right time and people with cancer are diagnosed and treated as quickly and efficiently as possible.

Paper co-author Associate Professor Marie Pirotta is a GP and NHMRC Career Development Fellow based at the Department of General Practice at the University of Melbourne. She said: “These striking findings are the first to identify how important the role is that GPs play in overall cancer outcomes. GPs have a difficult job to do. Many common symptoms may be due to an underlying cancer. GPs have to weigh up probabilities and ensure those who need tests or referrals to specialists get them, without overloading the health system.

“In Australia we are lucky our health system is delivering better cancer outcomes than in comparable countries overseas, and we must ensure the right support and resources remain in place so that doesn’t change.”

* Rose, P. et al. Explaining variation in cancer survival between eleven jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey. BMJ Open. 2015. The survey was completed in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (United Kingdom), Denmark, Norway, and Sweden.

** The figures for NI and Wales vary. ENG CT= 21.5%; MRI=19.9%. NI CT= 27.5%; MRI = 11.0%. Wales CT= 46.3; MRI= 31.2%. Compared to 91.6% for MRI in Ontario and close to 100% for CT in Australia.