Yin Zhou1, Fiona M Walter1, Hardeep Singh2, William Hamilton3, Gary A Abel3, Georgios Lyratzopoulos4. 1. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Worts' Causeway, Cambridge CB1 8RN, UK. 2. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. 3. College of Medicine and Health, University of Exeter Medical School (Primary Care), Exeter EX1 1TX, UK. 4. Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK.
Abstract
BACKGROUND: In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. We examined how quickly bladder and kidney cancer patients who met fast-track referral criteria were actually diagnosed. METHODS: We used linked primary care and cancer registration data on bladder and kidney cancer patients who met fast-track referral criteria and examined the time from their first presentation with alarm features to diagnosis. Using logistic regression we examined factors most likely to be associated with non-timely diagnosis (defined as intervals exceeding 90 days), adjusting for age, sex and cancer type, positing that such occurrences represent missed opportunity for timely referral, possibly due to sub-optimal guideline adherence. RESULTS: 28%, 42% and 31% of all urological cancer patients reported no, one or two or more relevant symptoms respectively in the year before diagnosis. Of the 2105 patients with alarm features warranting fast-track assessment, 1373 (65%) presented with unexplained haematuria, 382 (18%) with recurrent urinary tract infections (UTIs), 303 (14%) with visible haematuria, and 45 (2%) with an abdominal mass. 27% overall, and 24%, 45%, 18% and 27% of each group respectively, had a non-timely diagnosis. Presentation with recurrent UTI was associated with longest median diagnostic interval (median 83 days, IQR 43-151) and visible haematuria with the shortest (median 50 days, IQR 30-79). After adjustment, presentation with recurrent UTIs, being in the youngest or oldest age group, female sex, and diagnosis of kidney and upper tract urothelial cancer, were associated with greater odds of non-timely diagnosis. CONCLUSION: More than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients. The findings highlight a substantial number of opportunities for expediting the diagnosis of patients with bladder or kidney cancers.
BACKGROUND: In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. We examined how quickly bladder and kidney cancerpatients who met fast-track referral criteria were actually diagnosed. METHODS: We used linked primary care and cancer registration data on bladder and kidney cancerpatients who met fast-track referral criteria and examined the time from their first presentation with alarm features to diagnosis. Using logistic regression we examined factors most likely to be associated with non-timely diagnosis (defined as intervals exceeding 90 days), adjusting for age, sex and cancer type, positing that such occurrences represent missed opportunity for timely referral, possibly due to sub-optimal guideline adherence. RESULTS: 28%, 42% and 31% of all urological cancerpatients reported no, one or two or more relevant symptoms respectively in the year before diagnosis. Of the 2105 patients with alarm features warranting fast-track assessment, 1373 (65%) presented with unexplained haematuria, 382 (18%) with recurrent urinary tract infections (UTIs), 303 (14%) with visible haematuria, and 45 (2%) with an abdominal mass. 27% overall, and 24%, 45%, 18% and 27% of each group respectively, had a non-timely diagnosis. Presentation with recurrent UTI was associated with longest median diagnostic interval (median 83 days, IQR 43-151) and visible haematuria with the shortest (median 50 days, IQR 30-79). After adjustment, presentation with recurrent UTIs, being in the youngest or oldest age group, female sex, and diagnosis of kidney and upper tract urothelial cancer, were associated with greater odds of non-timely diagnosis. CONCLUSION: More than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients. The findings highlight a substantial number of opportunities for expediting the diagnosis of patients with bladder or kidney cancers.
Authors: Kyle A Richards; Vania Lopez Ruiz; Daniel R Murphy; Tracy M Downs; E Jason Abel; David F Jarrard; Hardeep Singh Journal: Urol Oncol Date: 2017-11-21 Impact factor: 3.498
Authors: W S Tan; A Ahmad; A Feber; H Mostafid; J Cresswell; C D Fankhauser; S Waisbrod; T Hermanns; P Sasieni; J D Kelly Journal: J Intern Med Date: 2019-01-04 Impact factor: 8.989
Authors: Dorothee Amelung; Katriina L Whitaker; Debby Lennard; Margaret Ogden; Jessica Sheringham; Yin Zhou; Fiona M Walter; Hardeep Singh; Charles Vincent; Georgia Black Journal: BMJ Qual Saf Date: 2019-07-20 Impact factor: 7.418
Authors: Yin Zhou; Gary A Abel; William Hamilton; Hardeep Singh; Fiona M Walter; Georgios Lyratzopoulos Journal: Cancer Epidemiol Date: 2020-04-22 Impact factor: 2.984
Authors: Yin Zhou; Fiona M Walter; Luke Mounce; Gary A Abel; Hardeep Singh; Willie Hamilton; Grant D Stewart; Georgios Lyratzopoulos Journal: Br J Gen Pract Date: 2021-12-31 Impact factor: 5.386
Authors: Hannah Harrison; Juliet A Usher-Smith; Lanxin Li; Lydia Roberts; Zhiyuan Lin; Rachel E Thompson; Sabrina H Rossi; Grant D Stewart; Fiona M Walter; Simon Griffin; Yin Zhou Journal: Br J Gen Pract Date: 2021-12-31 Impact factor: 5.386