Thursday, November 10, 2016

Can safety netting improve cancer detection in patients with vague symptoms ?

BMJ: There is an assumption that following up people with symptoms  which are low risk but no risk of cancer will improve cancer pick  up. But experts writing in The BMJ today say that we do not  know whether this approach works. Nor, do we understand the best way to do it. Patients visit their doctor every day about symptoms that could  be cancer. Some will have easily recognised high risk symptoms  such as difficulty swallowing (dysphagia) or coughing up blood  (haemoptysis). But most will have vague or non - specific  symptoms like cough, fatigue, or abdominal pain, where the  likelihood of cancer is low . Faced with this uncertainty, doctors have a responsibility to  avoid causing unnecessary alarm and wasting scarce resources  through over - investigation, which may re sult in harm to the  patient.
But this must be balanced with the potential harm of  delaying a diagnosis of serious disease . Safety netting is regarded as “best practice” for cancer diagnosis  - allowing doctors to tease out serious disease by following up  patients over time , for example by asking them to come back if  the symptom hasn't resolved, or to watch out for new symptoms . So Dr Brian Nicholson and colleagues at the University of Oxford  searched for evidence on whether and how safety netting can be  done effectively as part of a project funded by Cancer Research  UK . They found little evidence on whether it improves cancer  detection. They found some evidence on how best to do it in  patients with vague symptoms. They discuss three main issues: the  necessary components of  safety netting, the roles of patient and doctor, and the problems  arising from miscommunication or misinterpretation of initial test  results . Based on this evidence, the authors recommend ways that  doctors and patients can work to gether to safety net more  productively. Doctors should explain uncertainty about the cause  of symptoms with patients, and ensure that they understand  why, when and with who they should re - consult about which  concerning symptoms . Healthcare organisations  should also have systems in place to  ensure that test results are reviewed by somebody with  knowledge of cancer guidelines, and that positive and negative  results are communicated to the patient promptly . Although the evidence base is uncertain, safety n etting remains  the best option, and is likely better than nothing,” say the  authors. “It is important that patients continue to visit their doctor  until their symptoms are explained. We know that doctors are  safety netting every day to keep their patients  safe. By  conducting research on safety netting we will be able to  understand which safety netting messages and systems are  effective. ”