Public Release: 

Lack of referrals for suspected cancer leads to more deaths

Cancer Research UK


IMAGE: The association between urgent referral and death was consistent for the main types of cancer. view more

Credit: Cancer Research UK

DEATHS are higher in cancer patients whose GPs do not regularly send patients through the two-week urgent referral route for suspected cancer, according to a Cancer Research UK and National Institute for Health Research-funded study*.

The research - published today (Wednesday) in the British Medical Journal - examined data** from 215,284 English cancer patients. Researchers from King's College London found a clear link between the chance a patient would die, and the likelihood of their GP practice to refer cancer patients to a specialist using the two-week urgent referral route.

Death rates increased by seven per cent in patients from practices which used the two-week urgent referral route least often compared with practices with a typical referral rate.

The urgent two-week referral pathway for patients with suspected cancer was created in England in the early 2000s. The frequency with which GPs use the service varies across England. And the impact on cancer survival of referring cancer patients to specialists via this route has not been previously measured.

Lead author Professor Henrik Moller****, epidemiologist at King's College London, said: "This study shows the first link between using the urgent referral route and deaths in cancer patients.

"Increasing a GP's cancer awareness and their likelihood of urgently referring cancer patients could help reduce deaths. There's a fine line to tread between using the urgent referral route regularly and using it too much - which the NHS isn't equipped to respond to. But if GP practices which use the two-week route rarely, were to use it more often, this could reduce deaths of cancer patients."

Sara Hiom, Cancer Research UK's director of early diagnosis, said. "This crucial evidence shows that the earlier a cancer patient is diagnosed the better the chances of survival. Earlier cancer can be treated more effectively with a wider range of treatment options. And tumours can progress if there's a delay in time to diagnosis and starting treatment.

"It's never been clearer that reducing late diagnosis saves lives and this research adds to our understanding of what can be done about it. Cancer Research UK is committed to investing in early diagnosis research to support GPs refer suspected cancer as early as practically possible."


For media enquiries please contact the Cancer Research UK press office on 020 3469 8300 or, out-of-hours, the duty press officer on 07050 264 059.

Notes to editors:

*Association between use of the English urgent referral pathway for suspected cancer and mortality outcome in cancer patients: cohort study. 2015, British Medical Journal.

The study was supported by Cancer Research UK and the National Institute for Health Research Biomedical Research Centre (NIHR BRC) at Guy's and St Thomas' NHS Foundation Trust.

**Data was from English national cancer waiting Times database of patients with a date of first hospital appointment or treatment in 2009 compiled by Meechan et al. BJGP 2012; 62: e590-7

***Table. The association between urgent referral and death was consistent for the main types of cancer.

Group Patients % Deaths HR 95% CI
High referral ratio and high detection rate 34,758 16 14,355 0.95 0.94 0.97
Average 121,692 57 51,533 1.00
Low referral ratio and low or intermediate detection rate. 58,834 27 25,732 1.07 1.05 1.08
p-trend Less than 0.001

Hazard ratios adjusted for age, sex and cancer type.

****Professor Henrik Moller leads the Section of Cancer Epidemiology and Population Health in King's College London, and he is the Director of Cancer Epidemiology and Population Health in King's Health Partners (KHP) Cancer Centre.

About NAEDI:

The National Awareness and Early Diagnosis Initiative is a public sector/third sector partnership. It is led by Cancer Research UK, the Department of Health, NHS England and Public Health England. They work in partnership with other public and voluntary sector organisations to support and drive forward work on early diagnosis.

The role of NAEDI is to coordinate and provide support to activities and research that promote the earlier diagnosis of cancer.

NAEDI is an England-based initiative, but much of the research and insight generated is likely to be relevant to other nations.

About the National Institute for Health Research:

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (

About Cancer Research UK

  • Cancer Research UK is the world's leading cancer charity dedicated to saving lives through research.
  • Cancer Research UK's pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.
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