ObjectivesThe International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.DesignA validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.Participants2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.Primary and secondary outcome measuresAnalysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.Results4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.ConclusionsWe demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer—either directly, or by specialist referral, to improve outcomes.

Cachexia is a prevalent condition, affecting both patients with localized and metastatic cancer. Clinical attention to the condition is a sizeable unmet need.

The build-up and depth-dose characteristics of a conventional "6 MV" beam can be maintained when changing to a flattening-filter-free modality by increasing the incident electron energy from 6.45 MeV to 8.0 MeV. This will at the same time reduce the out-of-field dose for regions up to 20 cm from the central axis by 10%-30% compared to the original FF situation.

The incident electron beam parameters in a Monte Carlo model of a linear accelerator could be precisely and independently determined by the benchmarking procedure proposed. As the dose distribution in the penumbra region is insensitive to moderate changes in electron energy and angular spread, accurate penumbra measurements is feasible for benchmarking the electron radial intensity distribution. This parameter is particularly important for accurate dosimetry of mlc-shaped fields and small fields.