Childhood cancer diagnoses are difficult and can be easy to miss
- 80% of children with childhood cancer already have evidence of cancer spread at diagnosis.
- The nature of primary care, the numbers of patients that are seen each day and the pressures faced means that there are a number of ways that children with cancer could potentially be missed.
- Often children may see a different practitioner at each attendance and there is often limited feedback from other professionals if for example the same child saw the health visitor, Accident and emergency, the nurse practitioner and 2 GPs (5 different presentations).
- Childhood cancer can present with similar symptoms to other common childhood illnesses.
- A misconception that cancer in children is incredibly rare. It is not common but an average GP will see several children with cancer during their career, so it is important to have in the back of your mind.
- Children can’t often tell you what is wrong.
- Lack of awareness of the signs and symptoms amongst parents and professionals.
- A lot of parental anxiety about self- limiting illnesses which makes it harder to identify the children with serious illnesses.
Remember, sick kids do not always look sick. Listen to the concerns of the caregiver.
Interventions that may help earlier identification of cancer
- If you have some concerns (but not enough to act on at first presentation), prebook a follow up appointment if you can, or say when to come back. If they cannot see you again, record in the notes the symptoms that need to be followed up by the next person consulting.
- Know the signs and symptoms - order some awareness cards for the clinicians in your surgery.
- Always examine a child if they have symptoms, even if they look well. This is vital. If it is not possible to examine them then bring them back.
- Ask a carer how many times their child has been seen by healthcare professionals for that particular problem.
- Safety net, safety net, safety net. Many childhood cancers are difficult to pick up at the first presentation, but with adequate safety netting (where, when and why), many can be identified on a return presentation.
When should our alarm bells ring?
- Beware of persistent symptoms
- Pain that does not respond to simple analgesia
- Unusual symptoms or worsening despite simple interventions
- A change in attendance rates (for example a family that usually attend infrequently suddenly attending frequently.)
- Attendance 3 or more times increases risk of symptoms being due to cancer up to 10-fold.*
- Consider referral if parents or carers have persistent concerns, even if symptoms are more likely to have a benign cause.
* Dommet R, Redaniel T, Stevens M, Martin R, Hamilton W (2013). Risk of childhood cancer with symptoms in primary care: A population-based case-control study. British Journal of General Practice 63(606), e22-e29. doi: 10.3399/bjgp13X660742