Chamber and committees

This information is not held centrally.

No specific medical guidelines exist regarding the diagnosis and treatment of secondary cancer, however, SIGN guidelines:

http://www.sign.ac.uk/index.html exist in relation to many specific cancer types which include advice on management of different stages of cancer, whether local, advanced or metastatic disease.

Irrespective of initial cancer type, no patients are routinely screened for secondary cancers.

The national screening programmes for cancers (breast, bowel and cervical) are set up to identify pre-cancers and early cancers. Following identification of any cancer, individuals will follow care pathways determined by their test results and this pathway may identify either metastases or secondary cancer. An appropriate investigation may be ordered by the clinician caring for the patient. This decision will be based on clinical judgement and based on the individual''s circumstances, response to initial treatment and any symptoms a patient may present with.

GPs are trained to gather and interpret information from their patient based on history, physical examination and investigations relevant to the presenting problem. They are expected to be familiar with how patients present in the early stages of illness, and also in the management of long-term conditions, including shared care with other specialists which includes conditions like cancer. They should be aware of worrying symptoms, and recognise conditions or symptoms which may be serious and intervene urgently when required.

Local and national guidelines (for example, SIGN Guidelines), local clinical pathways and best practice statements such as those developed by NHS Quality Improvement Scotland are also available to help support GPs in their work. It is also important to make the relevant information available to health care professionals at the time a patient presents with relevant history, signs and symptoms. This can be achieved, for example, through prompts on the computer screen or advice from specialists following haematological and biochemical investigations for non-specific symptoms.

The annual appraisal process helps GPs to indentify their learning needs to address the healthcare needs of their patients and their carers, which they can address through Continuing Professional Development initiatives. GPs are supported by health boards, post graduate deaneries, NHS Education for Scotland and others, to undertake continuing professional development, so that they may acquire the required up to date knowledge and skills. The Royal College of GPs Scotland also facilitates education and training on various topics. Most health boards in Scotland also resource a Protected Learning Time initiative. This helps the practices in a locality to close the practice for half day a month so that all practice team members can then undertake training jointly or separately as planned and appropriate, organised by the health boards and their Community Health Partnerships.
GPs also access information through other means and in a variety of formats, for example, GP magazines (such as GP and Pulse), BMJ Learning, Doctors.net and other medical journals.

Numerous factors, for example, stage of disease at initial presentation, other co-morbidities, lifestyle factors and tumour biology, can all influence the likelihood of patients developing secondary cancer. Therefore, this level of risk cannot be linked specifically to the type of cancer initially diagnosed.

No specific guidelines exist regarding the identification of patients who are at a high risk of developing secondary cancer however, SIGN guidelines (http://www.sign.ac.uk/index.html) exist in relation to many specific cancer types. These cover all aspects of a patients care, for example, from initial referral, diagnosis, investigations, appropriate treatments for specific disease types, and follow up care, with the aim of improving outcomes for all cancer patients.

Breast cancer patients who have undergone surgery as their primary treatment are subject to clinical follow up in the form of post operation checks and the provision of advice; this type of support is also from oncologists following radiotherapy or chemotherapy, where this is deemed the most appropriate treatment for an individual.

In addition to this, patients are invited, when they become eligible, to participate in the national breast screening programme that is available to women between the ages 50 and 70.

SIGN guidelines and NHS Quality Improvement Scotland Standards for Breast Cancer, include guidance and standards on supportive care for patients with breast cancer.

In addition to this, work is underway to inform health boards of the newly established national information and support service, NHS inform, in which a dedicated cancer zone will provide quality assured cancer information for patients, carers and families. This will also include access to cancer support groups for breast cancer patients and information on emotional and financial support.

All NHS boards work within multidisciplinary teams (MDTs). MDTs are informed by the development in cancer strategies over the past 10 to 15 years and more recently by the recommendations within Better Cancer Care, an Action Plan, (2008) in which supportive care comprising the management of information, communication, access to the voluntary sector is integral to the overall health and well being of cancer patients, including breast cancer.

Health boards also provide Clinical Nurse Specialists which breast cancer patients will have access to. Each Clinical Nurse Specialist will be aware of the support available from both other health service based organisations and the voluntary sector, for example, Breast Cancer Care, Macmillan Cancer Support, Maggie''s centres and local support services and how these can be accessed. The Clinical Nurse Specialist will be able to provide advice relevant to the individual needs.

Patients are not routinely scanned for secondary cancer, however, clinicians may decide to undertake further investigative tests if individuals are displaying symptoms that suggest their disease has metastasised.

Cancer patients are not routinely scanned for secondary (metastatic) disease.

At the point of initial diagnosis, clinicians undertake diagnostic tests to ascertain the spread of the disease, the result of which influence both the treatment pathway for the individual patients and the care offered post treatment.

The use of X-rays and CT scans are subject to UK-wide legislation, including the Ionising Radiation (Medical Exposure) Regulations IR(ME)R 2000, which includes a specific requirement that each individual exposure must be justified by a practitioner, taking account of the health risks associated with exposure of the patient to ionising radiation. It is therefore for the practitioner to determine which diagnostic procedures are appropriate for each individual cancer patient.