Project title	Age- and Sex-Stratified Upper Thresholds for Platelet Count in Primary Care-Ordered Blood Tests for Expedited Cancer Diagnosis: HELP Flag
Lay summary	To answer the question: What effect is the High or Elevated Level of Platelets care pathway Flag (HELP Flag) having on the diagnosis of cancers locally? In this project we will: Evaluate HELP Flag’s impact: We will work out how much difference there is in the number, type and stage of cancers and how they were diagnosed using HELP Flag. Assess cost-effectiveness: We will work out what it means for NHS budgets if HELP Flag was used nationally. We will look at what things remain uncertain following our data collection and provide recommendations for future research. Improve acceptability and usability, and produce the materials required for roll-out: We will ask patients, doctors, and other key people to help improve HELP Flag. Together, we will create materials to help patients and doctors understand HELP Flag. We will create a plan so that HELP Flag can be rolled out across the country. Rationale After reviewing data from more than six million older adults in Canada, England and Australia, scientists found the natural variation in platelet count could be used to diagnose cancer sooner. The NHS Peninsula Cancer Alliance (local to Devon, Cornwall and the Isles of Scilly), University of Exeter and Royal Devon University Healthcare NHS Foundation Trust (RDUH) has used these and connected research findings, as well as national NHS cancer pathway development work, to design and implement an NHS-backed local early pilot service that uses commonly requested blood tests to flag patients to their GPs to aid early diagnosis sooner. The aim is to provide better patient care and outcomes and help the region to shift care from hospital to community. As early adopters of the HELP Flag, the Peninsula Cancer Alliance has been funded by the NHS to meet the aims (evaluate, assess and improve) above. The alliance disseminates this funding as needed within their local general practices. Patients often have blood tests when recommended by their general practitioner (GP) or hospital doctor. A measurement that is routinely made as part of this is the number of a cell type called platelets in the blood. Platelets are a part of the blood involved in stopping bleeding. Platelet counts differ in healthy people, depending on their age and whether they are male or female. However, a high level of platelets can sometimes be an early sign of cancer. Currently, some people with high platelet counts are not referred for further testing. If their high count is due to cancer, this can mean diagnosis is missed and only made later when the cancer has progressed. Interpreting these standard blood tests this way could help GPs spot cancer warning signs sooner. As part of the pilot, the RDUH Blood Sciences Laboratory has been using an algorithm that considers factors such as a patient's age and sex when analysing whether a raised blood platelet level could indicate cancer. The HELP Flag alert is then sent to GP practices with additional advice on what steps to take next. Method The HELP Flag is an alert on blood test results that shows high levels that takes into account normal differences between men and women and different ages. HELP Flag alerts doctors to patients (who have had a recent routine blood test) with an unexplained raised platelet count and includes advice for doctors on which tests to offer. The HELP Flag pathway is designed to complement, rather than replace, current haematology referral and advice and guidance pathways. We will evaluate whether cancer diagnosis happens faster and earlier across different types of cancers and for different patient groups, as earlier diagnosis would mean cancer patients will live longer and are more likely to be cured. HELP Flag uses the standard blood test that is already in routine use in the NHS, so it gives excellent value for money. The evaluation team, which includes general practitioners, will also assess if there are overall cost benefits to implementation of the pathway and how the service could be improved to increase uptake. What data will used? We require platelet count results and results of any subsequent tests (e.g., other blood tests, faecal immunochemical tests) from the laboratory, linked to cancer referrals and diagnoses from the hospital trust(s). We will also use interview and focus group data from clinical staff who use the pathway to help understand their experiences. Data within the South West SDE study are selected from all patients in Devon aged >59 years whose clinical team have ordered the platelet count blood test from Royal Devon University Hospital’s (RDUH) Blood Sciences Laboratory since HELP Flag inception, where the test result is greater than or equal to the HELP Flag thresholds. Project duration HELP Flag is being used in practice now and has been since January 2025. Final data collection will happen in February 2027. The project will run until June 2027.
Public benefit statement	Anticipated benefits The HELP Flag innovation has the potential to make it easier for GPs to spot possible cancer early using routine blood test results. By checking platelet counts, which can be a warning sign for cancer, HELP Flag helps find cancer sooner - especially in people aged 60 and older, where a link between high platelets and cancer is stronger. If cancer is caught early, patients are more likely to get treatment before it becomes harder to treat, which could save the NHS money by reducing expensive emergency diagnoses and the need for late-stage therapies. Extra benefits include freeing up resources so NHS staff can help more people sooner. HELP Flag is already being used in about 60 GP practices in Devon, and some patients are getting help from it now. The project plans to expand to 2–4 more areas next, and if it succeeds, there are plans to roll it out nationally. In the pilot, we expect around 3,000 people to have a blood test where high platelet counts are found and the test is flagged for further investigation with around 120 of these being diagnosed with cancer. It will take more time for all the benefits for patients - like living longer because cancer is found sooner - to be fully realised. How might research be detrimental to the public? There are several ways that the research could potentially cause harm. These are outlined below along with our plans for managing the risk. GPs not referring patients onwards when HELP Flag is raised. We will support and encourage primary care uptake of the pathway by holding a series of GP education events, supported the Peninsula Cancer Alliance and the Manchester Cancer Alliance, to inform the community of the innovation. The HELP pathway was co-designed with input from multiple clinical stakeholders, including GPs, haematologists, and members of the Peninsula Cancer Alliance. Flagged patients worrying whilst waiting for tests results from onward referral due to the potential of a cancer diagnosis. Guidance provided to GPs on what HELP Flag means to aid discussion with patients. NHS capacity to process increased referrals. Tests suggested within the pathway are commonplace with low levels of backlog. Our local audit revealed that the likely number of extra referrals in Devon will be around 100; this represents less than 3% of all urgent cancer referrals in the region annually. The Cancer Alliances have facilitated discussion and input from specialties who may be impacted by the introduction of HELP Flag. Identification of cancers which would not otherwise require treatment (over-diagnosis). Considered relatively unlikely due to the high level of emergency admissions associated with HELP Flag without referral in published studies of cancer diagnosis following raised platelet count. HELP Flag will only be applied to patients who are already engaging with healthcare services and having a full blood count. Patients who do not have this encounter will not benefit from HELP Flag.
Unique identifier of the project	SDE_SW_PROJ_03
Legal name of contracting organisation	University of Exeter
Date of countersigned contract	14 May 2026
Health research classification system (HRCS) category	Blood, Cancer
Current project status	Live - data in use
Multiple-SDE project indicator	No
Is SDE the lead SDE in this project?	Not applicable
Name of SDE parties	Not applicable
Further information	https://helpflag.com/