GP is reviewing person I care for face to face today. I think there is a suspicion of cachexia based on exceptionally low creatine (liver function). The result is about as low as it can be. There are some physical signs of wasting becoming apparent now too, though it's hard to admit it (hollowing cheeks, skinny ankles, loss of strength, belly grows but nothing else). My friend is eating about double what most people would eat in a day, so appetite remains good, but exercise is becoming harder and less effective.
GP had previously held off doing a new cancer referral while more tests were undertaken. When a GP suspects someone is starting to waste are they allowed to completely ignore new red flag cancer symptoms? Does this recent blood test result mean my friend will be refused any form of new Consultant referral? What are the protocols here? (I had accepted there would be no surgery, but to be totally written off is hard.)
Also, is cachexia possible with early stage cancers? I thought it was something that only appeared late-stage? (I do fully understand cachexia could be related to a co-morbidity rather than a cancer issue.)
It just feels so horrible if doctors will no longer refer to hospital for any investigations. It's starting to feel like they are no longer interested in what is causing things, just tinkering around with symptom management. Are there any NICE or other guidelines which say how cancer red flags should be treated when there are co-morbidities? Is there anything it would be helpful for me to know here?
I find it extremely hard when other people say go back to GP, they should be investigating these new cancer red flags. Doctors can treat these things. My friend went to GP, but it does seem normal rules are out the window. Doctors just say your systems are packing up, your brain is dying. But if they don't investigate things, would that mean no palliative care? Is there a stage at which they have to investigate?
I'm so confused by everything and really don't know how to manage this situation. Or what to say to people who think new cancer symptoms are being stupidly ignored. What on earth do I say to these people? I appreciate you may not be able to answer my questions. But, if there is any information that you feel it would be useful to know I'd be grateful if you could signpost me to it.
I should add perhaps that there had been previous cancer surgery, which was felt to have brought about a full cure with discharge back to GP after five years of monitoring during which there was some further surgery.
My friend is only in his sixties, it's not like he's super old.
Thank you.
