More than four in 10 people who are eventually diagnosed with cancer have to see their GP at least twice before being referred for tests, a new report shows.
The NHS National Cancer Patient Experience Survey, completed by 73,817 people with cancer, found thousands had to make repeat visits to family doctors before eventually being sent for tests.
Of 51,973 people who saw their GP with symptoms, 15% had to go back three or four times before they were eventually referred to hospital for further investigation.
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Almost one in 10 (8%) saw their GP five or more times while a fifth (20%) went to their GP twice.
Overall, 43% of people who saw a GP with symptoms had to go at least twice before being referred for tests.
The survey, carried out on behalf of NHS England, found that while most people rate their overall experience of NHS cancer care highly, some areas performed significantly worse in 2018 than in 2017.
When asked how they felt about the length of time they had to wait before their first appointment with a hospital doctor, 83.6% of patients said they were seen as soon as they thought was necessary - "significantly lower" than the 84.2% in 2017, the report said.
When asked to rate the administration of their care, such as getting letters at the right time and doctors having the right notes and test results, 88.5% of patients said that this was "good" or "very good" - again "significantly lower" than the 89.6% score in 2017.
Just 35% of patients received a care plan setting out their treatment and goals.
Some 86.7% of patients said they waited about the right length of time for their tests to be done, down on the 87.3% the year before.
But a slightly higher proportion of people than the previous year said there were always enough nurses on duty during their treatment, and there were also higher scores for being given information about side-effects, pain control and privacy.
Overall, asked to rate their care on a scale of zero (very poor) to 10 (very good), NHS patients gave an average rating of 8.8.
Ruth May, Chief Nursing Officer for England, said: "Patients' satisfaction with their cancer care remains at a record high with nine out of 10 patients happy with the care and support they've received, which is testament to the hard work and compassion of NHS staff.
"This is despite record numbers getting checked for cancer and surviving it, with 2.2 million getting checked for cancer last year.
"The NHS Long Term Plan will ensure that even more people receive earlier cancer checks alongside the best possible care and lifesaving new treatments."