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As every awareness-raising campaign makes clear, anyone with cancer has a better chance of surviving it, the earlier it is found.
It is called Jess’s Rule because it was triggered by a young woman called Jessica Brady, who had 20 GP appointments for symptoms including a persistent cough and abdominal pain. After five months, she sought private treatment and finally learned that she had terminal cancer. She lived only three more weeks.
So, why is Jess’s Rule needed and why is it sometimes so hard for GPs to recognise possible cancer symptoms?
A missed cancer diagnosis is also something that GPs fear. “We dread missing any significant diagnosis where the delay will affect the prognosis – cancer is going to be the commonest cause of that,” said Dr Keith Hopcroft, a doctor in Essex, who has written a book for GPs called Symptom Sorter.
In 2023, this was changed in England to a 28-day target for the time between GP referral and getting a diagnosis. Scotland, Wales and Northern Ireland have other targets for the time between referral and treatment.
A major problem, though, is that about half of cancers cause symptoms that don’t indicate the tumour type, or even any tumour at all. Such “non-specific” symptoms include fatigue, all-over pains, nausea, feelings of dizziness or weight loss when someone isn’t on a diet.
Ping pong between hospital and GP
We shouldn’t underestimate the difficulty for GPs in distinguishing the tiny number of people with a tumour from the majority with less serious illnesses. A full-time GP may see about seven of their registered patients develop cancer a year, out of several thousand patient consultations.
To avoid this, hospitals in England now have a new system for people with non-specific cancer symptoms, where patients have a panel of blood tests as well as a full-body CT scan.
Showing how important that is, gut feeling was the second most common reason for GPs to refer on the non-specific symptom pathway, according to a recent study by Dr Friedemann Smith.
Nevertheless, the health system failed her and the consequences were devastating. What lessons can be learned and will Jess’s rule help?
Physician associates are less-qualified health care professionals that the NHS is introducing to free up doctors for more difficult tasks. But there is an ongoing row over what jobs physician assistants should be able to do.
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And earlier this year, the Royal College of General Practitioners created new training materials that incorporate the “three strikes” guide.
“Hopefully it will make a difference for some of the patients who slip through the net,” said Dr Friedemann Smith.
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But the overall impact of Covid is likely to be much less this winter than during the first years of the pandemic, thanks to repeated infections building up people’s immunity. In fact, Covid can easily be mistaken for flu or a cold.
I’ve been watching
It seems to have about five different plot lines going on at once, and the ambassador’s personal life is about as tangled as Middle East politics. While I need subtitles on to keep track of what’s happening, I’m already hooked.
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