Use this guideline to guide referrals. If still uncertain about whether a referral is needed, consider contacting a specialist (see the recommendations on the diagnostic process). Consider a review for people with any symptom associated with increased cancer risk who do not meet the criteria for referral or investigative action (see the recommendations on safety netting).
Discuss with people with suspected cancer (and their carers, as appropriate, taking account of the need for confidentiality) their preferences for being involved in decision‑making about referral options and further investigations including their potential risks and benefits. [2015]
When cancer is suspected in a child, discuss the referral decision and information to be given to the child with the parents or carers (and the child if appropriate). [2015]
Explain to people who are being referred with suspected cancer that they are being referred to a cancer service. Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss alternative diagnoses with them. [2015]
Give the person information on the possible diagnosis (both benign and malignant) in accordance with their wishes for information (see also NICE's guideline on patient experience in adult NHS services). [2015]
The information given to people with suspected cancer and their families and/or carers should cover, among other issues:
where the person is being referred to
how long they will have to wait for the appointment
how to obtain further information about the type of cancer suspected or help before the specialist appointment
what to expect from the service the person will be attending
what type of tests may be carried out, and what will happen during diagnostic procedures
how long it will take to get a diagnosis or test results
whether they can take someone with them to the appointment
who to contact if they do not receive confirmation of an appointment
other sources of support. [2015]
Provide information that is appropriate for the person in terms of language, ability and culture, recognising the potential for different cultural meanings associated with the possibility of cancer. [2015]
Have information available in a variety of formats on both local and national sources of information and support for people who are being referred with suspected cancer. For more information on information sharing, see the section on enabling patients to actively participate in their care in NICE's guideline on patient experience in adult NHS services. [2015]
Reassure people in the safety netting group (see recommendation 1.15.2) who are concerned that they may have cancer that with their current symptoms their risk of having cancer is low. [2015]
Explain to people who are being offered safety netting (see recommendation 1.15.2) which symptoms to look out for and when they should return for re‑evaluation. It may be appropriate to provide written information. [2015]
When referring a person with suspected cancer to a specialist service, assess their need for continuing support while waiting for their referral appointment. This should include inviting the person to contact their healthcare professional again if they have more concerns or questions before they see a specialist. [2005]
If the person has additional support needs because of their personal circumstances, inform the specialist (with the person's agreement). [2005]
Ensure that the results of investigations are reviewed and acted upon appropriately, with the healthcare professional who ordered the investigation taking or explicitly passing on responsibility for this. Be aware of the possibility of false‑negative results for chest X‑rays and tests for occult blood in faeces. [2015]
Consider a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet the criteria for referral or other investigative action. The review may be:
planned within a time frame agreed with the person or
patient‑initiated if new symptoms develop, the person continues to be concerned, or their symptoms recur, persist or worsen. [2015]
Take part in continuing education, peer review and other activities to improve and maintain clinical consulting, reasoning and diagnostic skills, in order to identify at an early stage people who may have cancer, and to communicate the possibility of cancer to the person. [2005]
Discussion with a specialist (for example, by telephone or email) should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed. This may also enable the primary healthcare professional to communicate their concerns and a sense of urgency to secondary healthcare professionals when symptoms are not classical. [2005]
Put in place local arrangements to ensure that letters about non-urgent referrals are assessed by the specialist, so that the person can be seen more urgently if necessary. [2005]
Put in place local arrangements to ensure that there is a maximum waiting period for non-urgent referrals, in accordance with national targets and local arrangements. [2005]
Ensure local arrangements are in place to identify people who miss their appointments so that they can be followed up. [2005]
Include all appropriate information in referral correspondence, including whether the referral is urgent or non-urgent. [2005]
Use local referral proformas if these are in use. [2005]
Once the decision to refer has been made, make sure that the referral is made within 1 working day. [2005]