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.
The data suggests that, while NHS patients given an urgent referral will wait a similar amount of time to see a specialist as private patients, those given a routine referral will wait longer. Six per cent of private patients waited no time between getting a referral and seeing a specialist compared to 1% of urgently and routinely referred NHS patients (both 1%). However, while around 70% of both private and urgently-referred NHS patients waited less than two weeks, just 12.8% of routine patients saw a specialist within this time. Over half of these routinely referred patients had to wait more than a month, compared to just 8% of private patients.
For common cancers, the difference between a private and NHS referral in terms of getting a quick diagnosis may not be great. Overall, more than half of cancer patients are given an urgent referral, rising to three-quarters of breast cancer patients, half of colorectal and lung cancer patients and 55% of prostate cancer patients.
However, a much lower proportion of patients with rarer cancers get an urgent (two-week) referral – 12.8% of brain cancer patients, 22% of leukaemia patients and 35% of liver cancer patients. These patients are much more likely to be diagnosed as an emergency – including 39% of brain cancer patients – where outcomes are likely to be worse.
The Government’s current cancer strategy states that GPs need to be able to directly access tests for patients whose symptoms do not warrant an urgent referral but require further investigation, including MRI for brain cancer diagnosis and ultrasound for ovarian cancer.
In 6% of cases in this study, the GP believed that better access to investigations would have reduced delay in diagnosis, rising to 20% for brain cancer, where GPs want better access to CT and MRI scanning.
The audit was conducted as part of the National Awareness and Early Diagnosis Initiative (NAEDI), which was established to enable the NHS to better understand and address the reasons for later diagnosis of cancer in England, believed to be a major cause of poorer survival outcomes compared to other countries.