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By Scott Harding-Lister, Clinical Negligence Solicitor and Medico-Legal Expert
When cancer is diagnosed later than it should have been, patients and their families can understandably have questions about whether earlier action by their GP could have made a difference. Scott Harding-Lister and our Clinical Negligence team advise patients and families where there are concerns that cancer symptoms, abnormal results or other warning signs were not investigated or referred appropriately.
A delayed cancer diagnosis does not necessarily mean that there has been clinical negligence. Cancer can be difficult to identify, particularly where symptoms could reasonably indicate a number of different conditions.
However, there are circumstances where the care provided should be investigated more closely.
This may be the case where symptoms or clinical findings should reasonably have prompted further investigation or an urgent referral, but appropriate action was not taken. It is then necessary to consider a second and equally important question: did the delay affect the patient’s treatment, prognosis or overall outcome?
Scott Harding-Lister and our Clinical Negligence team can help patients and families understand what happened, whether the care provided fell below a reasonable standard and whether an avoidable delay caused additional harm.
Can you claim if a GP missed cancer symptoms?
A clinical negligence claim may be possible if a GP failed to respond appropriately to symptoms, signs, abnormal test results or risk factors that should reasonably have prompted further investigation or referral.
However, establishing that an opportunity for earlier diagnosis was missed is only one part of a potential claim.
It is also necessary to establish causation. This means considering whether an earlier referral or investigation would probably have resulted in an earlier diagnosis and, importantly, whether that would have changed what happened to the patient.
For example, expert evidence may need to consider whether earlier diagnosis could have:
- allowed treatment to begin sooner;
- provided access to different treatment options;
- prevented the cancer from progressing further before treatment;
- improved the patient’s prognosis; or
- avoided additional pain, treatment or other harm.
These questions are highly dependent on the individual circumstances and usually require specialist medical evidence.
What cancer symptoms should a GP refer?
There is no single list of symptoms that automatically means a GP should make an urgent cancer referral.
Cancer can present in many different ways, and a GP must consider symptoms alongside factors such as the patient’s age, medical history, risk factors, examination findings and test results.
Depending on the circumstances, potentially significant features may include:
- an unexplained lump or swelling;
- unexplained bleeding;
- persistent or unexplained weight loss;
- changes in bowel habits;
- breast changes;
- persistent unexplained pain;
- abnormal blood test results; or
- a patient repeatedly attending with the same or worsening symptoms.
The important question in a clinical negligence case is not simply whether cancer was eventually diagnosed. It is whether the information reasonably available to the GP at the relevant time should have led to further investigation or referral.
What is an urgent suspected cancer referral?
NICE publishes guidance on the recognition and referral of suspected cancer.
The guidance identifies symptoms, clinical findings and combinations of factors that may warrant further investigation or referral through a suspected cancer pathway.
NICE guidance can therefore be important when investigating a delayed cancer diagnosis. It may help establish what action should reasonably have been considered based on the symptoms and information available at the time.
However, NICE guidance does not determine whether clinical negligence has occurred. Each case must be considered individually, taking account of the patient’s presentation, the decisions made by the healthcare professionals involved and appropriate expert medical evidence.
When could a delayed cancer referral amount to clinical negligence?
A delay may warrant further investigation where, for example:
- potentially concerning symptoms were not appropriately investigated;
- abnormal test results were not acted upon;
- a patient repeatedly returned with persistent or worsening symptoms without appropriate escalation;
- a referral was not made when it reasonably should have been;
- a referral was made through an inappropriate pathway;
- relevant risk factors were not properly considered; or
- there was a failure to follow up tests, investigations or referrals.
These circumstances do not automatically establish negligence. They can, however, provide a reason to examine the medical records and obtain expert evidence about the standard of care.
Why does the length of the delay matter?
The length of a delay can be important, but it does not provide the answer on its own.
A relatively short delay may be significant for some cancers, while a longer delay may not have altered the treatment or prognosis in another case.
This is why Scott and the team look beyond the date on which cancer was eventually diagnosed.
They consider the complete clinical timeline, including when symptoms first appeared, what was reported to the GP, what investigations were undertaken, whether symptoms changed or persisted, when referrals were made and what subsequently happened.
That chronology can help identify whether there was a missed opportunity for diagnosis and, if so, what difference earlier action might realistically have made.
Why is causation important in a delayed cancer diagnosis claim?
Causation is often one of the most complex parts of a delayed cancer diagnosis claim.
It is not enough to establish that cancer could have been diagnosed earlier. A successful clinical negligence claim will generally also need evidence that the delay probably caused additional harm.
Specialist experts may therefore need to consider questions such as:
At what stage was the cancer likely to have been at the time an earlier referral should have occurred?
Would investigations at that point probably have identified it?
Would treatment have been different?
Would the patient’s prognosis probably have been better?
Did the delay lead to additional or more invasive treatment?
The answers will depend upon the type of cancer and the individual patient’s circumstances.
What evidence is needed to investigate a missed cancer diagnosis?
The medical records are usually central to understanding what happened.
Depending on the circumstances, Scott and his team may need to consider records including:
- GP consultation notes;
- details of previous symptoms and attendances;
- referral records;
- blood test results;
- imaging and scan reports;
- pathology results;
- hospital and clinic correspondence;
- cancer pathway dates;
- multidisciplinary team (MDT) records;
- treatment records; and
- any complaint correspondence.
A detailed chronology can then be built showing what information was available, when decisions were made and whether there were points at which further investigation or referral should reasonably have taken place.
Independent medical experts may also be instructed where appropriate to consider both the standard of care and the effect of any delay.
How Scott Harding-Lister and his team assess delayed cancer diagnosis cases
For someone who has recently received a cancer diagnosis, investigating whether something went wrong earlier can feel daunting. There may be years of medical appointments and records to understand, alongside the immediate impact of diagnosis and treatment.
Scott Harding-Lister and our Clinical Negligence team approach these cases by first establishing a clear picture of what happened.
This can include considering:
- when symptoms were first reported;
- whether there were recognised warning signs or risk factors;
- what investigations were arranged;
- whether abnormal results were appropriately followed up;
- whether symptoms persisted or worsened;
- whether a referral should have been made earlier;
- when the cancer was ultimately diagnosed; and
- what difference earlier diagnosis may have made.
Where appropriate, Scott and the team work with independent medical experts to assess the care provided and the likely consequences of any delay.
The purpose of this initial investigation is to give patients and families a clearer understanding of the circumstances and whether there is evidence to support taking the matter further.
Speak to our Clinical Negligence team about a delayed cancer diagnosis
If you are concerned that cancer symptoms were missed, an abnormal result was not acted upon or a referral should have been made sooner, Scott Harding-Lister and our Clinical Negligence team can help you understand your options.
Every case is different. An initial review can help establish the relevant timeline, identify the records and evidence that may be required and consider whether the circumstances warrant further investigation.
Frequently asked questions about missed and delayed cancer referrals
Can you claim if a GP missed cancer symptoms?
Potentially. A claim may be possible where a GP failed to act reasonably on symptoms, clinical signs, abnormal results or relevant risk factors and that failure led to an avoidable delay which caused additional harm. Both the standard of care and the effect of the delay need to be considered.
Does a delayed cancer diagnosis automatically mean clinical negligence?
No. A delay does not automatically establish negligence. It is necessary to consider whether the care provided fell below a reasonable standard and whether earlier diagnosis would probably have changed the patient’s treatment, prognosis or outcome.
What symptoms can be relevant to a missed cancer diagnosis?
This depends on the individual circumstances and type of cancer. Persistent unexplained symptoms, lumps, unexplained bleeding, weight loss, bowel changes, breast changes, abnormal blood results and repeated attendances with continuing or worsening symptoms may all be relevant.
Why is NICE suspected cancer guidance important?
NICE guidance sets out symptoms and clinical findings that may require investigation or referral for suspected cancer. It can be relevant when considering what action a reasonable GP should have taken, although it does not determine by itself whether clinical negligence occurred.
Can I claim if my cancer would still have developed anyway?
The question is usually not whether the cancer itself was caused by negligence. In delayed diagnosis cases, the issue is whether an avoidable delay caused additional harm. For example, expert evidence may consider whether earlier diagnosis would probably have resulted in different treatment, a better prognosis or the avoidance of additional harm.
What medical records are needed for a delayed cancer diagnosis claim?
Relevant evidence can include GP notes, blood test results, referral records, imaging, pathology, hospital correspondence, cancer pathway dates, MDT records and treatment records. The precise evidence required will depend upon the circumstances.
How do you prove that an earlier cancer diagnosis would have made a difference?
This will usually require independent expert medical evidence. Experts may consider when the cancer was likely to have been detectable, its probable stage at an earlier point and whether earlier diagnosis would probably have changed treatment or prognosis.
How long do I have to make a clinical negligence claim for delayed cancer diagnosis?
Clinical negligence claims are subject to legal time limits, but when that period begins can depend on the circumstances, including when a person knew, or could reasonably have known, that their injury may have been connected to the treatment they received. Different rules can also apply in some circumstances. It is sensible to obtain legal advice as early as possible if you are considering a claim.
This article provides general information and is not a substitute for legal advice on an individual case.
