Improving outcomes for patients with colorectal cancer

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Dr Anwar Khan World Cancer Day

To mark World Cancer Day, Dr Anwar Khan, Senior Clinical Advisor (General Practice) for NHS Resolution, describes his dedication and work in early diagnosis of colorectal.

One in two people will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are: breast, lung, prostate and bowel (colon and rectum). On average, there are 42,886 new bowel cancer cases each year in the UK and approximately 16,600 bowel cancer deaths. That’s 45 bowel cancer deaths a day, accounting for 10% of all cancer deaths and making bowel cancer the second most common cause of cancer death in the UK. Yet, colorectal cancer is amenable to cure, if it’s detected early.

To mark World Cancer Day, 4 February 2022, we spoke with Dr Anwar Khan, Senior Clinical Advisor (General Practice) for NHS Resolution about his dedication and work in diagnosing colorectal cancer in patients early.

Anwar, please tell us about yourself

I’m a GP principal in Waltham Forest in East London and Senior Clinical Advisor (General Practice) for NHS Resolution. I qualified from Westminster Medical School in 1982. I first trained as a GP, but then took a professional detour by spending two or three years working in genetics. After a while, I realised that my vocation is being a GP, because of its emphasis on promoting care in the community, where I returned to work in 1991.

My GP career spans more than 35 years. I’ve been heavily involved in not only being a GP, but in supporting GPs education and assessment nationally and internationally. I’m an Examiner for the Membership of the Royal College of GPs (RCGP) of the UK, as well as Medical Director of International Accreditation in RCGP. Until 2019, I also worked in senior commissioning roles. In essence, all my roles are driven by a passion to promote patient safety and safe systems around the hard working professionals are on the frontline.

Please tell us about your role at NHS Resolution

Applying to work at NHS Resolution is probably the best thing I did in 2020. We are a learning organisation – always talking to each other and promoting personal and professional development.

At NHS Resolution I work closely with Ellen Nicholson, Safety and Learning Lead (General Practice). Our role is to collaborate with General Practice, in order to maximise learning from claims, reduce any future harm and support early and effective engagement with primary care. Ellen’s helped me to understand primary care claims, what the trends are and how to engage with relevant stakeholders to promote NHS Resolution’s work in primary care.

The NHS Resolution Safety and Learning team is completely multi professional. For me, it continues to be a pleasure to learn from colleagues who have a range of backgrounds, such as nursing, academia, paediatrics and podiatry. I enjoy learning about their priorities, such as Nicole Mottolini’s soon to be published thematic analysis on patients with diabetes and lower limb complication. What I liked about reviewing Nicole’s work was the qualitative information that has potential to highlight patients’ stories, which is more powerful than a list of numbers.

More than anything, patients remain our raison d’etre, don’t they? From a patient’s point of view, claims are the tip of the iceberg of their dissatisfied journey. One of the things I am keen to encourage is to engage with primary care colleagues early, for example, at the level of the patient’s initial complaint, before it reaches a claim.

Please describe your work in colorectal cancer and incontinence and how you aim to improve outcome for patients

Creating a colorectal clinic in the community

As it is World Cancer Day, it’s important to note that despite bowel cancer being the second cancer most likely to cause cancer in the UK, that needn’t be the case, because it’s the easiest of the cancer to treat if it’s detected early. Bowel cancer is preventable through regular screening. Which is what gave us the inspiration to begin a colorectal cancer clinic in Waltham Forest.

Fund-holding in the early 90s, allowed colleagues and I to develop “Teach and Treat” clinics in primary care.  We brought secondary care consultants to see our patients and their feedback improved our medical knowledge and hence more appropriate referrals. End of fundholding lead to the demise of these clinics. However, in 2008, an opportunity arose in Waltham Forest to start a colorectal cancer clinic in the community, regularly screening patients for bowel cancer.  As you can see from the chart below, Waltham Forest had higher net survival rates than the rest of England for the survival rate of patients with colorectal cancer. Of the factors affecting this positive trend, I hope that very much this has been influenced by our colorectal clinic seeing patients early:

One-year net survival index for colorectal cancer aged 15-99 years

Raising awareness of colon cancer symptoms

GPs encouraging patients to be aware of colon cancer and its symptoms is important. It is critical to look out for sinister symptoms such as, unintentional weight loss, change in bowel habits or blood mixed in the faeces. Also important we should ask about family history of cancer; “think genetics” allows relevant patients to be referred early for bowel cancer screening.

Where do you think working for NHS Resolution brings the most value for you?

Understanding claims in primary care, what the trends are and how to engage with relevant stakeholders to promote NHS Resolution’s work in primary care is incredibly important for improving patient outcomes. Learning about the systemic factors that contribute to patient outcomes not only maximises learning from claims but also promotes the activities that reduce harm within primary care. By raising awareness of the trends seen from the claims and promoting that discussion and particularly reflection with our colleagues in the front line is important to reduce harm to patients.

Another key pillar of NHS Resolution is sharing learning for improvement when things go wrong in healthcare, which really resonates with me because it is so important to prevent the same thing happening again. Patient stories are the major driver for sharing learning and driving change. After all, patients are our reason being.

What does the future look like for detecting colorectal cancer in patients?

NHSE has proposed that from 2022/23, Faecal Immunochemical Tests (FIT) will be introduced in primary care to support patient colorectal cancer referrals; these tests detect invisible traces of blood in faeces. The use of FIT tests during the covid pandemic has been extremely useful to prioritise patients for endoscopies when access to colonoscopies was limited. I would suggest that FIT testing should be used as the “first line of defence” screening option, before a colonoscopy. However, it is important to ensure the instructions for patients are clear in order to minimise false positives.

Learn more about NHS Resolution Safety and Learning