Clare Pearson1, Jess Fraser2, Michael Peake3, Roland Valori4, Veronique Poirier5, Victoria H Coupland6, Sara Hiom5, Sean McPhail7, Jodie Moffat5, Georgios Lyratzopoulos7, Jon Shelton8. 1. Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4AD, UK; National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Rd, London, SE1 8UG, UK. Electronic address: clare.pearson@cancer.org.uk. 2. Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4AD, UK; National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Rd, London, SE1 8UG, UK. 3. National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Rd, London, SE1 8UG, UK; University College London Hospitals (UCLH) Cancer Collaborative, UCLH Cancer Division, 47 Wimpole Street, London, W1G 8SE, UK; Respiratory Medicine, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK. 4. National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Rd, London, SE1 8UG, UK; Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK. 5. Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4AD, UK. 6. National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Rd, London, SE1 8UG, UK. 7. National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Rd, London, SE1 8UG, UK; ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. 8. Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4AD, UK. Electronic address: jon.shelton@cancer.org.uk.
Abstract
BACKGROUND: Diagnostic timeliness in cancer patients is important for clinical outcomes and patient satisfaction but, to-date, continuous monitoring of diagnostic intervals in nationwide incident cohorts has been impossible in England. METHODS: We developed a new methodology for measuring the secondary care diagnostic interval (SCDI - first relevant secondary care contact to diagnosis) using linked cancer registration and healthcare utilisation data. Using this method, we subsequently examined diagnostic timeliness in colorectal and lung cancer patients (2014-15) by socio-demographic characteristics, diagnostic route and stage at diagnosis. RESULTS: The approach assigned SCDIs to 94.4% of all incident colorectal cancer cases [median length (90th centile) of 25 (104) days] and 95.3% of lung cancer cases [36 (144) days]. Advanced stage patients had shorter intervals (median, colorectal: stage 1 vs 4 - 34 vs 19 days; lung stage 1&2 vs 3B&4 - 70 vs 27 days). Routinely referred patients had the longest (colorectal: 61, lung: 69 days) and emergency presenters the shortest intervals (colorectal: 3, lung: 14 days). Comorbidities and additional diagnostic tests were also associated with longer intervals. CONCLUSION: This new method can enable repeatable nationwide measurement of cancer diagnostic timeliness in England and identifies actionable variation to inform early diagnosis interventions and target future research. Crown
BACKGROUND: Diagnostic timeliness in cancerpatients is important for clinical outcomes and patient satisfaction but, to-date, continuous monitoring of diagnostic intervals in nationwide incident cohorts has been impossible in England. METHODS: We developed a new methodology for measuring the secondary care diagnostic interval (SCDI - first relevant secondary care contact to diagnosis) using linked cancer registration and healthcare utilisation data. Using this method, we subsequently examined diagnostic timeliness in colorectal and lung cancerpatients (2014-15) by socio-demographic characteristics, diagnostic route and stage at diagnosis. RESULTS: The approach assigned SCDIs to 94.4% of all incident colorectal cancer cases [median length (90th centile) of 25 (104) days] and 95.3% of lung cancer cases [36 (144) days]. Advanced stage patients had shorter intervals (median, colorectal: stage 1 vs 4 - 34 vs 19 days; lung stage 1&2 vs 3B&4 - 70 vs 27 days). Routinely referred patients had the longest (colorectal: 61, lung: 69 days) and emergency presenters the shortest intervals (colorectal: 3, lung: 14 days). Comorbidities and additional diagnostic tests were also associated with longer intervals. CONCLUSION: This new method can enable repeatable nationwide measurement of cancer diagnostic timeliness in England and identifies actionable variation to inform early diagnosis interventions and target future research. Crown
Keywords:
Colorectal cancer; Diagnostic intervals; Early detection of cancer; Early diagnosis; England; Lung cancer; Population-based cancer registries; Secondary care
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