Abstract

"If I had symptoms I worried about - and it could be cancer - how should my healthcare system take responsibility for my diagnostic pathway?"

The public demand for fast high-quality cancer diagnosis and treatment is evident. Real-life stories confirm that the trust in a healthcare system basically depends on the fulfilment of this demand. Unexplained differences in cancer survival between countries, regions and population groups make us wonder why apparently similar treatment seems to result in different outcomes. A key issue is the interface between primary and secondary care, not least the access to cancer investigations and their efficiency in the use of healthcare resources.

But how do we create a responsible healthcare system? And what would the effect be? Huge international efforts have been made aiming to ensure high-quality cancer care. Yet, an increasing awareness of the insufficiency of the classical cancer diagnosis has evolved in recent years, with the UK in the driver's seat.

The prevailing idea in many healthcare systems has been that increasing public awareness in itself will promote a rational demand for primary care; the GP will refer relevant patients, on the basis of guidelines, to diagnostic work-up, which will ensure expedited cancer diagnosis.

A responsive primary-care sector is the first step in meeting the patients' needs. But is general practice always accessible? Do clinicians have sufficient knowledge of cancer risk? Would it be a dangerous idea to give GPs direct access to investigations?

This plenary will present experiences, from a health-services perspective, with the organisation of faster pathways from first symptom to treatment. A particular focus will be set on guideline-based primary cancer diagnosis, access to investigations and the leadership in making the optimal pathways for cancer diagnosis. We will also discuss inefficient use of healthcare resources; waste, duplication and 'double-gatekeeping' understood as the lack of integration between primary care and hospitals.