Return cancer test results within 10 days, NHS England tells hospitals

3rd May 2023

NHS England has tasked hospitals with turning around diagnostic test results for suspected cancer within 10 days.

Hundreds of patients who have been referred under the urgent pathway will receive faster news about whether they have cancer or not helping to reduce anxiety and start treatment more quickly, NHS England said.

A letter sent to local health leaders has also asked teams to prioritise diagnostic tests like MRI scans for cancer in community diagnostic centres (CDCs) or to free up capacity within hospitals by moving elective activity into the centres. 

Earlier this month, figures showed more than 42% of patients are waiting more than 62 days for their first cancer treatment from urgent GP referral.

Worst ever cancer waiting times

It follows a report from the Public Accounts Committee in March which warned that cancer waiting times are at their worst ever level and NHS England was unlikely to meet its recovery target of moving back to 85% treated within 62 days of referral.

But the latest figures did show some improvement in two week wait times from the previous month with 86% of people seen by a specialist within a fortnight of urgent referral up from 81%.

In February, NHS England said it achieved the faster diagnosis standard for suspected cancer for the first time, with three quarters of those referred receiving a definitive diagnosis or all clear within 28 days – 171,453 people.

There has been high demand for services with up to one in four GP referrals a month for cancer.

In March 2022 to Feb 2023, 470,000 more people were checked for cancer compared with the same period before the pandemic, the figures show.

There are now 105 CDCs in place and offering a ‘one stop shop’ for tests, NHS England confirmed.

‘Significant progress’

Dame Cally Palmer, NHS national director for cancer, said: ‘It is a testament to the hard work of NHS staff that we are seeing and treating record numbers of patients for cancer, and have made significant progress bringing down the backlog and achieving the target for diagnosing three quarters of people within 28 days – all despite huge demand and pressures on the system.

‘Fortunately, the vast majority of suspected cancer patients waiting for a diagnostic test will not have cancer, but for those waiting it can be a very anxious time, so we are asking trusts to aim for a 10-day turnaround time between GP referral and tests results for patients – so we can get people the all-clear faster, or in some cases ensure patients diagnosed with cancer are able to start treatment sooner.’

Professor Mike Osborn, president of the Royal College of Pathologists, said: ‘We welcome the announcement of support for pathology services which will help our members provide the quicker diagnoses that patients need.

‘Pathologists have long asked for improvements in digital pathology and infrastructure to help them provide better patient care. We fully support this initiative and the fresh focus on pathology which it should provide will, we hope, make a real difference to patients.’

This news story was originally published by our sister publication Pulse.

Combined thin film and rapid diagnostic test an effective malaria screen

11th August 2021

A malaria screen based on the use of a thin film and a rapid diagnostic test has been shown to be an effective within emergency departments.

Malaria is caused by the Plasmodium falciparum parasite and is spread to humans after being bitten by an infected female Anopheles mosquito. Malaria is extremely common and according to data from the World Health Organisation, in 2019, there were an estimated 229 million cases of malaria across the world and approximately 409,000 deaths. Symptoms of malaria include non-specific flu-like illness with fever, sweats and chills. Although malaria is endemic in sub-Saharan Africa and South East Asia, the disease still occurs in those who have returned from travelling to malaria areas. For example, in 2018, there were 1683 cases of imported malaria in the UK and this figure has remained remarkably constant over the past 10 years. An important first step in the management of travellers is a malaria screen to identify those with the condition. According to UK guidelines published in 2016, the best diagnostic procedure is examination of thick and thin blood films by an expert to detect the presence of the malarial parasite. Moreover, the guidelines also recognise that malaria can also be accurately diagnosed using rapid diagnostic tests (RDTs). In fact, a Cochrane review concluded that RDTs have a high sensitivity such that these can replace or extent the access of diagnostic services for uncomplicated plasmodium falciparum (P. falciparum) malaria. Guidance from the Haematology Task Force, has recommended that if the initial malaria screen is negative despite a strong clinical suspicion of infection, the films should be repeated after 12 to 24 hours and again after 24 hours. Nevertheless, this requires the patient to return to a hospital for repeat testing and it cannot be guaranteed that someone likely to be infected will return to a hospital. Thus, in order to optimise the malaria screen process to ensure that patients are successfully identified and using a combination of thin film and RDTs, a team from the Emergency Department, Manchester University, Manchester, UK, undertook a retrospective analysis of the value of this single malaria screen consisting of a RDT and a thin film over a 5-year period.

Findings
The study included a complete malaria screen, i.e., thin film and RDT, for 1331 unique patients with an average age of 30.6 years (51.3% male). A total of 104 positive tests were identified from the screening of which 103 were for single malarial species (74 P. falciparum, 23 P. vivax, 6 P. ovale and one mixed infection). This gave a background malaria prevalence of 5.6% for P. falciparum and 7.8% for any species. Using this approach, the authors calculated the sensitivity for the detection of P. falciparum as 100% and the specificity was 99.4%. For the detection of any malaria species, the sensitivity was 99% and the specificity 99.5%.

The authors concluded that a single malaria screen using a combination of a thin film and a RDT is likely to be sufficient to identify P. falciparum in the returning traveller, avoiding the need for a return visit when the initial film is negative. They also called for further work to confirm the value of this approach.

Citation
Reynard C et al. A diagnostic evaluation of single screen testing for malaria in the returning traveller: A large retrospective cohort study. Acad Emerg Med 2021