scholarly journals Using linked English cancer registration data to assess variation in diagnostic pathway length

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jess Fraser ◽  
Clare Pearson ◽  
Jon Shelton ◽  
Jodie Moffat
Keyword(s):  
Secondary Care ◽  
Waiting Times ◽  
Patient Characteristics ◽  
Cancer Site ◽  
Diagnostic Process ◽  
Cancer Registration ◽  
Diagnostic Pathway ◽  
Registration Data ◽  
Emergency Presentation ◽  
Pathway Length

BackgroundFor the majority of cancer patients, the length of the diagnostic pathway is unknown. Only those on a specific pathway are monitored. Quantifying pathway length is important in understating which patients may benefit most from an expedited pathway. AimThis study aimed to develop a novel methodology using linked cancer registration data to calculate the Secondary Care Diagnostic Interval (SDCI): the period from first interaction with secondary care to receiving a cancer diagnosis. Subsequently variation in SCDIs across twenty-five cancer sites were analysed. MethodsEnglish cancer registrations (2014-15) from Public Health England’s National Cancer Registration and Analysis Service were linked to three routine health datasets: Hospital Episode Statistics, Diagnostic Imaging Dataset and Cancer Waiting Times. The SCDI was calculated as the difference between the earliest event relating to the secondary care diagnostic process (comprised of referral into/secondary care appointment or diagnostic procedure in the 6 months before diagnosis) and the diagnosis date. SCDI length was stratified by stage at diagnosis, route to diagnosis (e.g. emergency presentation, GP referral) and patient characteristics. ResultsThe median SCDI (days) was shortest for acute lymphoblastic leukaemia (ALL) (2) and longest for kidney (45). In general, SCDIs decreased with later stage (for example stage 1-4 colorectal: 35 to 20, lung: 75 to 25). Patients diagnosed after routine GP referrals had longest SCDIs compared to urgent referrals, for all sites except ALL. Geographical variation in SCDIs exists by Cancer Alliance, with the greatest differences compared to the England average observed for prostate cancer (median national SCDI: 28, Cancer Alliance range: 21 - 42). ConclusionSubstantial variation exists in SCDIs by cancer site, stage and presentation route. Many patients are experiencing SCDIs over 28 days, even those diagnosed via urgent GP referrals. Understanding variation can support creation of targeted initiatives to expedite diagnostic pathways where appropriate.

scholarly journals Using English National Cancer Registration and Linked Health Datasets to Assess Variation in Diagnostic Pathway Length for Colorectal and Lung Cancer Patients by Stage and Route to Diagnosis

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 75s-75s
Author(s):  
C. Pearson ◽  
J. Fraser ◽  
J. Shelton
Keyword(s):  
Lung Cancer ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Patient Characteristics ◽  
Cancer Site ◽  
Lung Cancer Patients ◽  
Factors Associated ◽  
Diagnostic Pathway ◽  
Pathway Length ◽  
Diagnostic Pathways

Background: Understanding factors that contribute to longer diagnostic pathways is important to improve efficiency of these pathways and can provide evidence for the implementation of the forthcoming 28-day Faster Diagnostic Standard (FDS) in England. This analysis uses linked national cancer registrations and other health datasets to define diagnostic pathway length and examine variation by route to diagnosis (RtD), stage and patient characteristics for colorectal and lung cancer patients. Aim: To achieve a more in-depth understanding of the diagnostic pathway for colorectal and lung cancer patients and identify particular factors associated with longer diagnostic pathways. Methods: English cancer registrations (2014 & 2015) diagnosed with colorectal and lung cancers (C18-20, C33-34) were linked to the hospital episode statistics, diagnostic imaging dataset, cancer waiting times and RtD data. Patients with multiple diagnoses or unknown RtD were excluded. To construct the pathway length, a start date was derived by defining the earliest relevant event (referral into/appointment in secondary care or diagnostic procedure) from available datasets in the 6 months prediagnosis. The pathway length was determined for each cancer site separately, by stage, RtD and patient characteristic. Regression analysis produced odds ratios (OR) of having a longer diagnostic pathway while controlling for other factors, including age, sex, comorbidities and deprivation. The longer pathway was defined as longer than the median days per cancer site. Results: Of 64,320 colorectal and 71,526 lung patients included, 99.5% and 99.8% respectively had at least one relevant first event recorded. The median pathway length (days) was 26 (IQR 11-56) for colorectal and 35 for lung (15-83). Pathway length decreased significantly with later stage (stage 1-4 - colorectal: 35 to 20, lung: 75 to 25) with significant variation also by presentation route and comorbidity score. Regression analysis showed that, after adjustment for other factors (including stage), patients on a GP referral route had an increased odds of a long pathway compared with the two week wait route (an urgent GP referral with a suspicion of cancer) (colorectal aOR: 4.5, lung aOR: 2.5). Patients diagnosed via emergency presentation route, which are predominantly late stage, had the shortest pathway length and reduced ORs of having a longer diagnostic pathway (colorectal aOR: 0.2, lung aOR: 0.4). Certain patient characteristics are also associated with longer diagnostic pathway length. Conclusion: There is substantial variation in diagnostic pathway length by stage and route for both sites and in many cases these pathways exceeded 28-days (colorectal: 45.3%, lung: 56.4%). Vague symptoms, comorbidities and other patient characteristics may make cancer more difficult to diagnose. Factors associated with longer waits could support the creation of targeted initiatives to reduce the diagnostic pathway length.

scholarly journals Interhospital referral of colorectal cancer patients: a Dutch population-based study

2021 ◽  
Author(s):  
A. K. Warps ◽  
◽  
M. P. M. de Neree tot Babberich ◽  
E. Dekker ◽  
M. W. J. M. Wouters ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Waiting Time ◽  
Secondary Care ◽  
Advanced Disease ◽  
Waiting Times ◽  
Tertiary Care ◽  
Disease Stage ◽  
Colorectal Cancer Patients ◽  
Tertiary Care Hospitals

Abstract Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

Cancer Patient Pathways shortens waiting times and accelerates the diagnostic process of suspected sarcoma patients in Denmark

Health Policy ◽  
2013 ◽  
Vol 113 (1-2) ◽  
pp. 110-117 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Akmal Safwat ◽  
Peter Vedsted ◽  
Katja Maretty-Nielsen ◽  
Bjarne Hauge Hansen ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Waiting Times ◽  
Diagnostic Process ◽  
Patient Pathways

scholarly journals Are inequalities in cancer diagnosis through emergency presentation narrowing, widening or remaining unchanged? Longitudinal analysis of English population-based data 2006–2013

2018 ◽  
Vol 73 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Annie Herbert ◽  
Gary A Abel ◽  
Sam Winters ◽  
Sean McPhail ◽  
Lucy Elliss-Brookes ◽  
...  
Keyword(s):  
Help Seeking ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Baseline Risk ◽  
Cancer Site ◽  
Age Group ◽  
Emergency Presentation ◽  
English Population ◽  
Diagnosis Of Cancer ◽  
Adjacent Group

BackgroundDiagnosis of cancer through emergency presentation is associated with poorer prognosis. While reductions in emergency presentations have been described, whether known sociodemographic inequalities are changing is uncertain.MethodsWe analysed ‘Routes to Diagnosis’ data on patients aged ≥25 years diagnosed in England during 2006–2013 with any of 33 common or rarer cancers. Using binary logistic regression we determined time-trends in diagnosis through emergency presentation by age, deprivation and cancer site.ResultsOverall adjusted proportions of emergency presentations decreased during the study period (2006: 23%, 2013: 20%). Substantial baseline (2006) inequalities in emergency presentation risk by age and deprivation remained largely unchanged. There was evidence (p<0.05) of reductions in the risk of emergency presentations for most (28/33) cancer sites, without apparent associations between the size of reduction and baseline risk (p=0.26). If there had been modest reductions in age inequalities (ie, patients in each age group acquiring the same percentage of emergency presentations as the adjacent group with lower risk), in the last study year we could have expected around 11 000 fewer diagnoses through emergency presentation (ie, a nationwide percentage of 16% rather than the observed 20%). For similarly modest reductions in deprivation inequalities, we could have expected around 3000 fewer (ie, 19%).ConclusionThe proportion of cancer diagnoses through emergency presentation is decreasing but age and deprivation inequalities prevail, indicating untapped opportunities for further improvements by reducing these inequalities. The observed reductions in proportions across nearly all cancer sites are likely to reflect both earlier help-seeking and improvements in diagnostic healthcare pathways, across both easier-to-suspect and harder-to-suspect cancers.

scholarly journals Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033008 ◽  
Author(s):  
Clare Pearson ◽  
Veronique Poirier ◽  
Karen Fitzgerald ◽  
Greg Rubin ◽  
Willie Hamilton
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Cross Sectional Study ◽  
Cancer Registration ◽  
Sectional Study ◽  
Cross Sectional ◽  
Site Specific ◽  
Registration Data ◽  
Referral Criteria ◽  
Specific Symptoms

IntroductionPatients presenting to primary care with site-specific alarm symptoms can be referred onto urgent suspected cancer pathways, whereas those with non-specific symptoms currently have no dedicated referral routes leading to delays in cancer diagnosis and poorer outcomes. Pilot Multidisciplinary Diagnostic Centres (MDCs) provide a referral route for such patients in England.ObjectivesThis work aimed to use linked primary care and cancer registration data to describe diagnostic pathways for patients similar to those being referred into MDCs and compare them to patients presenting with more specific symptoms.MethodsThis cross-sectional study linked primary care data from the National Cancer Diagnosis Audit (NCDA) to national cancer registration and Route to Diagnosis records. Patient symptoms recorded in the NCDA were used to allocate patients to one of two groups - those presenting with symptoms mirroring referral criteria of MDCs (non-specific but concerning symptoms (NSCS)) and those with at least one site-specific alarm symptom (non-NSCS). Descriptive analyses compared the two groups and regression analysis by group investigated associations with long primary care intervals (PCIs).ResultsPatients with NSCS were more likely to be diagnosed at later stage (32% stage 4, compared with 21% in non-NSCS) and via an emergency presentation (34% vs 16%). These patients also had more multiple pre-referral general practitioner consultations (59% vs 43%) and primary care-led diagnostics (blood tests: 57% vs 35%). Patients with NSCS had higher odds of having longer PCIs (adjusted OR: 1.24 (1.11 to 1.36)). Patients with lung and urological cancers also had higher odds of longer PCIs overall and in both groups.ConclusionsDifferences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.

scholarly journals What are the implications of using individual and combined sources of routinely collected data to identify and characterise incident site-specific cancers? a concordance and validation study using linked English electronic health records data

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037719
Author(s):  
Helen Strongman ◽  
Rachael Williams ◽  
Krishnan Bhaskaran
Keyword(s):  
Primary Care ◽  
Gold Standard ◽  
Cancer Registration ◽  
Data Sets ◽  
Death Registration ◽  
Case Definitions ◽  
Predictive Values ◽  
Site Specific ◽  
Registration Data ◽  
Electronic Health

ObjectivesTo describe the benefits and limitations of using individual and combinations of linked English electronic health data to identify incident cancers.Design and settingOur descriptive study uses linked English Clinical Practice Research Datalink primary care; cancer registration; hospitalisation and death registration data.Participants and measuresWe implemented case definitions to identify first site-specific cancers at the 20 most common sites, based on the first ever cancer diagnosis recorded in each individual or commonly used combination of data sources between 2000 and 2014. We calculated positive predictive values and sensitivities of each definition, compared with a gold standard algorithm that used information from all linked data sets to identify first cancers. We described completeness of grade and stage information in the cancer registration data set.Results165 953 gold standard cancers were identified. Positive predictive values of all case definitions were ≥80% and ≥94% for the four most common cancers (breast, lung, colorectal and prostate). Sensitivity for case definitions that used cancer registration alone or in combination was ≥92% for the four most common cancers and ≥80% across all cancer sites except bladder cancer (65% using cancer registration alone). For case definitions using linked primary care, hospitalisation and death registration data, sensitivity was ≥89% for the four most common cancers, and ≥80% for all cancer sites except kidney (69%), oral cavity (76%) and ovarian cancer (78%). When primary care or hospitalisation data were used alone, sensitivities were generally lower and diagnosis dates were delayed. Completeness of staging data in cancer registration data was high from 2012 (minimum 76.0% in 2012 and 86.4% in 2014 for the four most common cancers).ConclusionsAscertainment of incident cancers was good when using cancer registration data alone or in combination with other data sets, and for the majority of cancers when using a combination of primary care, hospitalisation and death registration data.

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