40% of cancer patients referred privately have cancer that has spread

Questions for insurers and employers on funding treatment for secondary cancer

A high proportion of cancer patients referred privately are diagnosed with a cancer that has already spread, according to a major study from the Department of Health.

The data raises questions for private medical insurance (PMI) providers and employers with regard to the funding of treatments for secondary cancer, which are often expensive and may not be approved by the National Institute for Health and Clinical Excellence (NICE).

The audit of cancer diagnosis in primary care tracked 18,879 patients across 1,170 GP practices (14% of all practices in England). Of these, 4.9% (931) were given a private referral, rising to 8% of men aged 55 and 10% of women aged 40.

At diagnosis stage, 47.5% of private patients had a cancer that had not spread, the same proportion as NHS patients given an urgent referral but lower than NHS patients given a routine referral (54%). A quarter of private cancer patients had a cancer that had spread locally while a further 17% had cancer that had spread to other organs.

Comprehensive cancer cover on PMI policies is a popular choice for both individuals and employers and Aviva UK Health recently announced that it was removing limits on cancer treatment, funding all treatment recommended by members' doctors. PruHealth has also reported that its full cancer cover option is a popular choice. Bupa has also launched NHS Cancer Cover Plus which will fund treatments not funded by NICE - which include several prescribed for patients with cancer that has spread.

Is access to diagnostics the problem?

The data also raises questions about whether speedier access to diagnostics is the key to improving cancer outcomes or whether the key is to encourage people to go to their GP sooner with potential cancer symptoms. The report identifies some "surprising patient delays" relating to alarm symptoms – 12% of patients with a breast lump, 26% of those with change in bowel habit and 20% of those with rectal bleeding delayed for more than two months before consulting.

A third of private patients went to a doctor as soon as they noticed symptoms, compared to 38.9% of NHS patients given an urgent referral to a specialist (to be seen by a specialist within two weeks as the GP suspects cancer) and 21.2% of patients given a routine referral (to be seen by a specialist but not necessarily within two weeks as the GP does not strongly suspect cancer). In total, three-quarters of private patients waited less than a month to see a doctor, similar to urgently-referred NHS patients but higher than routinely-referred NHS patients.

Intermediaries may wish to consider working with corporate clients to raise awareness of cancer symptoms to drive earlier diagnosis.

Private/NHS waiting times

In recent months private medical insurance (PMI) providers have launched products designed to fund access to diagnostics, including Aviva’s Speedy Diagnosis and Bupa’s NHS Cancer Cover Plus, which funds access to diagnostics and treatment not available on the NHS.

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