Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit

Abstract

Objective To characterize cancer diagnosis in Scottish primary care and draw comparisons with cancer diagnostic activity in England. Method A national audit of cancer diagnosis was conducted in Scottish and English general practices. Participating GPs collected diagnostic pathway data on patients diagnosed in 2014 from medical records. Data were supplemented by linkage to national cancer registries. Analysis explored and compared patient characteristics, diagnostic intervals, and routes to diagnosis. Results 7.7% of all Scottish general practices in 2017 provided data on 2,014 cancer diagnoses. 71.5% of cases presented to GPs and 37.4% were referred using the “Urgent‐Suspected Cancer” route. The median primary care interval was 5 days (IQR 0‐23 days) and median diagnostic interval was 30 days (IQR 13‐68). Both varied by cancer‐site. Diagnostic intervals were longer in the most remote patients and those with more comorbidities. Scottish and English samples corresponded closely in key characteristics. Conclusions Most people diagnosed with cancer in Scotland present to a GP first. Most are referred and diagnosed quickly, with variations by cancer‐site. Intervals were longest for the most remote patients. GPs in Scotland and England appear to perform equally but, in view of growing differences between health systems, future comparative audits may be informative.

Cancer diagnosis and treatment in the COVID‐19 era

“…Also in this issue, Murchie et al. (2020) report on an audit of cancer referrals from primary care in Scotland. This is clearly an important ongoing initiative to monitor such referrals and look for lessons about how primary care can more effectively recognise cancer symptoms and make appropriate referrals.…”

Impact of geography on Scottish cancer diagnoses in primary care: Results from a national cancer diagnosis audit

“…In 2016-17, Cancer Research UK, together with NHS partners, the Royal College of General Practitioners (RCGP) and Macmillan Cancer Support, conducted a National Cancer Diagnosis Audit (NCDA) in Scotland (Murchie et al, 2020). The aim of the NCDA was to understand primary care cancer diagnosis.…”

“…The analysis reported adopted similar data-definitions as those reported in the Scottish NCDA baseline paper (Murchie et al, 2020). Symptoms and positive signs recorded in NCDA as having been present at first consultations were mapped onto site-specific Scottish Referral Guidelines for Urgent Suspected Cancer by PM (Scottish Executive, 2014).…”

Is place or person more important in determining higher rural cancer mortality? A data-linkage study to compare individual versus area-based measures of deprivation

“…In the first model sociodemographic variables alone were added: age; sex; SIMD; urban-rural classification; and the Census variables found to be significant univariately (ethnic group, hours in main job, heating, country of birth, housing type). In the second model, the same adjustments made in the original NASCAR analysis were repeated on the current cohort, which included: age; sex; SIMD; urban-rural classification; referral status (screening, other, routine, urgent, urgent-suspected cancer); cancer type; treatment received; CCI; metastatic cancer [ 8 ]. In the third model, the individual-level Census variables found to have a significant association (p<0.05) with one of the outcomes (ethnic group, hours in main job, heating, birth in UK and housing type) were added to model 2.…”

“…The route to diagnosis and treatment for almost all people diagnosed with symptomatic cancer in Scotland will begin with consultation with a general practitioner (GP) [ 8 ]. Depending on the clinical features at presentation the GP can then either admit the patient directly to hospital or refer them to see a secondary care specialist at a hospital.…”