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Evaluation of risk assessment tools for suspected cancer in general practice: a cohort study

Hamilton, William; Green, Trish; Martins, Tanimola; Elliott, Kathy; Rubin, Greg; Macleod, Una


William Hamilton

Trish Green

Tanimola Martins

Kathy Elliott

Greg Rubin


Background: Diagnostic delay is deemed to account for an estimated 5000 to 10 000 extra cancer deaths each year in the UK. Many cancer patients do not have symptoms meeting national referral criteria for rapid investigation. Risk assessment tools (RATs) have been developed to assist GPs in selecting patient for cancer investigation. Aim: To assess the usability and acceptability of lung and colorectal RATs, as well as subsequent resource use and cancer diagnoses. Design and setting: Cohort study with nested qualitative study with 614 GPs from 165 practices in seven English cancer networks were provided with RATs applicable to patients aged ≥40 years with bowel or respiratory symptoms. In-depth interviews were conducted with 34 individuals (11 project managers and 23 GPs). Method: The study measured the number of RATs used, and subsequent cancer investigations and diagnoses, over a 6-month period and compared these with the previous 6 months. Results: A total of 2593 RATs (1160 lung, 1433 colorectal) were completed. Compared with the preceding 6 months, there were 292 more chest X-rays, 104 extra 2-week chest clinic appointments, and 47 additional diagnoses of lung cancer. For suspected colorectal cancer, there were 304 more 2-week referrals, 270 more colonoscopies, and 10 more cancers identified. RATs appeared to help GPs in their selection of patients for cancer investigation. Users reported that RATs helped to confirm a need for investigation as well as allowing reassurance when investigation was not needed. Conclusion: Use of RATs in primary care was accompanied by increased diagnostic activity and additional cancer diagnoses.


Hamilton, W., Green, T., Martins, T., Elliott, K., Rubin, G., & Macleod, U. (2013). Evaluation of risk assessment tools for suspected cancer in general practice: a cohort study. The British journal of general practice : the journal of the Royal College of General Practitioners, 63(606), (30-36). doi:10.3399/bjgp13X660751. ISSN 0960-1643

Journal Article Type Article
Acceptance Date Oct 24, 2012
Online Publication Date Jan 1, 2013
Publication Date Jan 1, 2013
Deposit Date Nov 13, 2014
Journal British Journal Of General Practice
Print ISSN 0960-1643
Electronic ISSN 1478-5242
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 63
Issue 606
Pages 30-36
Keywords Family Practice
Public URL
Additional Information Sherpa Romeo 21/9/16 Author's Pre-print: author cannot archive pre-print (ie pre-refereeing) Author's Post-print: author cannot archive post-print (ie final draft post-refereeing) Publisher's Version/PDF: No information archiving status unknown Nothing on article to suggest that it has been published as OA