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Education
Review
Conference report: improving outcomes for gastrointestinal cancer in the UK
  1. Ian Forgacs1,
  2. Rachel Ashton2,
  3. William Allum3,
  4. Terry Bowley4,
  5. Hilary Brown5,
  6. Michel P Coleman6,
  7. Rebecca Fitzgerald7,
  8. Michael Glynn8,
  9. Sara Hiom9,
  10. Roger Jones10,
  11. Michael Machesney11,
  12. Jane Maher12,
  13. Stephen P Pereira13,
  14. Robert Steele14,
  15. Andrew Veitch15,
  16. Steve Wyatt4
  1. 1 Kings College Hospital, London, UK
  2. 2 Ashton Editorial Consulting, London, UK
  3. 3 Royal Marsden NHS Foundation Trust, London, UK
  4. 4 The Elmhurst Practice, London, UK
  5. 5 College of Social Sciences, University of Birmingham, Birmingham, UK
  6. 6 London School of Hygiene and Tropical Medicine, London, UK
  7. 7 MRC Cancer Unit, University of Cambridge, Cambridge, UK
  8. 8 Royal London Hospital—Barts Health NHS Trust, London, UK
  9. 9 Cancer Research UK, London, UK
  10. 10 Royal College of General Practitioners, London, UK
  11. 11 Barts Health NHS Trust, London, UK
  12. 12 Macmillan Cancer Support, London, UK
  13. 13 UCL Institute for Liver and Digestive Health, London, UK
  14. 14 University of Dundee and Clinical Direction of Scottish Bowel Screening Programme
  15. 15 New Cross Hospital, Wolverhampton, UK
  1. Correspondence to Dr Ian Forgacs, Department of Gastroenterology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; president{at}bsg.org.uk

https://doi.org/10.1136/flgastro-2016-100713

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    Introduction

    On 7 December 2015, the British Society of Gastroenterology and the Royal College of Physicians held a joint conference: GI cancer in the UK: can we do better? The meeting was timely as, although outcomes for patients with most gastrointestinal cancers in the UK have steadily improved in the past 10 years, survival figures remain substantially worse than in many other comparable nations.

    After defining the scale of the problem, the issues around early diagnosis were discussed. Screening as prevention has huge potential where there are defined premalignant conditions. Uptake into the Bowel Cancer Screening Programme (BCSP) is variable but in some areas remains low. It is hoped that with the National Screening Committee recommendation to replace the guaiac faecal occult blood test (gFOBT) with the faecal immunochemical test (FIT), the planned age extension and the continued roll-out of bowel scope screening by the National Health Service (NHS) will extend the value of the programme further.

    The view from primary care suggested that many factors affect the decision to make a referral for suspected cancer. Lack of direct access to testing was highlighted as a concern, as was the compounding issue of the many patients who delay seeking care. The Independent Cancer Force is the latest of several bodies calling for general practitioners (GPs) to be able to refer ‘direct to test’. However, a particular concern from secondary care relates to further stretching of diagnostic resources already under pressure—and how that can be addressed in times of austerity. Waiting times for endoscopy have begun to rise, yet capacity to expand is limited. Training, recruitment and retention of clinical staff were all highlighted as key issues limiting the availability of these procedures. Various practical ways to improve detection with endoscopy were proposed, as were possible ways to support and retain staff.

    While …

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