Background to cancer and cancer treatment

Below are some useful links to outline what cancer is, how it develops, and some of the treatments that are available. Understanding these things will help in Cancer Care review discussions.

Psychosocial Impact of Cancer

Cancer affects patients beyond just the physical symptoms. It can significantly impact on social life, mental health, finances and work to name a few. The holistic nature of the cancer care review aims to address issues beyond the physical symptoms. Below are some statistics from Macmillan research on some of the impacts of cancer:

  • Financial – Macmillan research shows that of all the people living with cancer, a staggering 83% experience a financial impact as a result of their diagnosis.
  • Mental health – Three quarters of people with cancer (75%) experience anxiety as a result of their cancer diagnosis
  • Relationships – A quarter (26%) of people with cancer say they experience difficulties in their relationships with their partner as a result of their cancer diagnosis

Patients often do not know where to turn, but there is support available for all these things.

The Cancer Care Review is an opportunity to discuss the things that primary care can address directly, and signpost to the wealth of resources that are available in their local community.

Why is the Cancer Care Review important?

More people are living longer with and beyond cancer, which means that the Primary Care team has a vital role to play in helping patients to manage their diagnosis and the effects of their treatment. The Cancer Care review aims to help equip patients to self-manage their symptoms and know where to seek support and help from services including local resources, support groups, and the GP practice itself.

Why personalised care?

We know that after a cancer diagnosis 83% of patients report themselves to be less well off. 25% report loneliness, 10% report anxiety, 40% report depression and 25% report physical symptoms affecting their QOL. There is support available for all of these things, and patients often do not know where to turn. The cancer care review is an opportunity to address the things that primary care can address directly, and signpost to the wealth of resources that are available throughout the GM area.

QOF targets

QOF targets for cancer include two indicators involving the Cancer Care Review. It highlights points in the cancer pathway which may be a key time of need for patients:

• within 3 months – an offer of a cancer care review and information given about support available from primary care

• within 12 months of diagnosis – the offer and delivery of a Cancer Care Review using a structured template

The Cancer Care Review Process

GM Cancer Alliance have designed a protocol to help practices follow through the process of the Cancer Care Review.

Download the protocol.

When a practice receives a new cancer diagnosis it should be coded to the notes, and clinicians should be notified; particularly the clinician who referred the patient for suspected cancer if relevant.

Clinicians may choose to contact the patient over the phone after they have been informed of their diagnosis. This gives the patient an opportunity to discuss their concerns and flag what support they may need. Part of this conversation should involve signposting to support services that are available locally.

This interaction should be coded in the notes as 

QOF targets outline that GPs should contact patients around the time of diagnosis, within the first three months (CAN005).

To facilitate this Greater Manchester Cancer have designed a New Diagnosis letter which can be modified by practices to meet their needs.

The letter can be sent to patients once they have been notified about their diagnosis. It informs them of the Cancer Care Review Process, how to prepare for the conversation, and offers them the opportunity to have a review before 3 months if they wish to take this up

Download the New Diagnosis Letter

Download an easy read version of the New Diagnosis Letter to edit and send to individuals with or learning disabilities or literacy difficulties.

Access our library of translated New Diagnosis Letters

To ensure the Cancer Care Review takes place within 12 months of diagnosis, the protocol suggests adding a diary date between 3-9 months to invite the patient to the Cancer Care Review. The review can be booked face to face, telephone or virtual dependant on patient preference.


What should a cancer care review include?

The Cancer Care review standards produced by GM Cancer Alliance outline the recommendations for the Cancer Care review. This includes offering them as a stand-alone appointment. This is an important time point, as at this point patients may no longer be under regular follow-up with secondary care, and hence it is a good opportunity to offer further support.

At the point of sending the cancer care review invite, a copy of the Macmillan concerns checklist can be sent for the patient to complete and return, or bring along with them. This helps them to think about the things that are important to them which they wish to discuss. MAC13689ConcernsChecklist17AWweb (

GM cancer alliance have developed recommended standards for the cancer care review. The development of this has been guided by Macmillan Cancer Care.

GM Cancer Alliance CCR standards

Macmillan have also developed Primary Care 10 Top Tips for carrying out a cancer care review.