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The government announcement of patients being guaranteed to see a specialist within 2 weeks for suspected cancer fails to impress neurologist Dr David Nicholl.

The last 10 years has seen an unprecedented investment in the NHS and one of the big government targets has been on waiting times - and there is now a two week wait for patients for suspected cancer.

Whereas there can be some rationale for this for some tumours, eg breast or bowel cancer, this has been a staggering waste of time and money in neurology. Quite simply, the symptoms of brain tumour are, in general fairly nebulous, whereas headaches are a very common symptom in the general population.

A while back, we estimated that 40% of all out-patient referrals in neurology were for headache, but only a tiny fraction of those will have a brain tumour. So introducing a 2 week wait for ‘suspected brain tumour’ only ends up swamping the system, leads to (expensive) unnecessary investigation, without any good evidence of improved quality of care.

A recent example shows how wasteful the system is. I was referred a 95 year patient with severe Alzheimer’s disease from a nursing home as a “2 week cancer wait”. He was seen 10 days after he’d complained of a headache.

The look on his daughter’s face said it all - “I’m embarrassed, why is my Dad here? This is a complete waste of time”?

“I agree, its to meet the target. Do you want your Dad to have a scan? It won’t change his management. Even if he did have a brain tumour - which I don’t think is the case- it would clearly be completely inappropriate to do anything about it in someone as frail as your Dad”.

We never did a scan - it would only have distressed him - but at least we met the wretched target.

Mad though this story is, in 7 years, I have yet to see a single patient referred as a “2 week cancer wait” who actually has a brain tumour. Why don’t we use the evidence in neurology to actually target something that would make a difference, eg rapid access TIA clinics for mini-strokes?

But then we couldn’t have politicians listening to people who know the subject, could we?



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