What is this research about?
The UK is not as good as other countries in diagnosing cancer early. It has been estimated that between 5,000-10,000 lives are lost each year as a result of late diagnosis. As the gatekeepers for most tests, GPs are in a difficult position. They feel under pressure from patients who are keen for tests to be undertaken to either identify or rule out cancer. At the same time, GPs don’t want to flood secondary care with referrals, especially in the current challenging economic climate. There is a need for well evidenced tools to support selection; aids that can help both GPs and patients.
A team led by researchers at the University of Exeter has developed new electronic risk assessment tools (otherwise known as eRATs) to help GPs identify possible cancer. The eRATs are housed within Macmillan’s electronic Clinical Decision Support (eCDS) software module, a medical device that can be embedded into the GP’s computers providing they are using one of the major software systems (e.g., EMIS, SystmOne, Vision).
The eRATs have two main functions: the prompt and the symptom checker. The prompt appears as a pop-up on screen when a patient has at least a 2% risk of one or more of the seven cancers in the eCDS software (lung, oesophago-gastric, kidney, bladder, ovary, colorectal, pancreas). GPs can explore the possibility of cancer further in consultation with the patient using the symptom checker function of the tool. The symptom checker allows the GP to add new symptoms and will automatically recalculate the risk of cancer.
The aim of the ERICA study is to assess the clinical and cost effectiveness of 6 eRATs –lung, oesophago-gastric, kidney, bladder, ovarian, and colorectal (we are not studying pancreas). We want to recruit 530 practices across England. Practices who join the trial will be randomly allocated to either the intervention arm, where they will receive access to the suite of eRATs, or to the control arm, where they will provide their usual care.
Our primary outcome is the cancer stage at time of diagnosis. We hope to see a 4.8% improvement in stage, making some previously incurable patients curable. If we do find this, then it adds up to approximately 6,000 cancer deaths avoided per year! Our secondary outcomes include an examination of the different routes through which patients get diagnosed (e.g., two week wait, GP referral), 30-day and 1-year survival rates.
All of our outcome data will be depersonalised (not personally identifiable) patient data collected over a two year period from national cancer registries – not from GP clinical systems.
A small proportion of practices from both trial arms will be offered additional nested studies which will look at:
- GP eRAT usage and GP and patient experience of care.
- Patients’ health resource use.
The trial will allow us to definitively answer the question of whether the eRATs are clinically effective, whether they help GPs catch cancer sooner. We will also be able to understand the cost consequences of the eRATs as well as their impact on secondary care service provision. Importantly, we will also get necessary information from both GPs and patients about their experience of the eRATs during the consultation.
What does the study involve? Click here to find out.