Diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions; findings from a cross-sectional study from the International Cancer Benchmarking Partnership (ICBP)

Abstract

ObjectiveInternational differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia).DesignPatients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients’ primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression.ParticipantsA total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses.Primary and secondary outcome measuresInterval lengths in days (primary), reported patient symptoms (secondary).ResultsThe main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was ‘bleeding/blood in stool’. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results.ConclusionICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.

Colon and rectal cancer survival in seven high-income countries 2010–2014: variation by age and stage at diagnosis (the ICBP SURVMARK-2 project)

“…In addition, variations in clinical and pathological practice with regards to clinical examinations, nodal assessment and the use of imaging technology to detect small lymph nodes or distant metastases may have contributed to differences in the composition of patients within a specific stage grouping. [27] It is therefore important to interpret findings from our study in light of local clinical practice, and to ensure that registries have data collection protocols that are as uniform as possible. [28] Another potential factor that may influence early detection is patients' behaviours towards symptoms, as these have been linked to diagnostic delays and can impact the time from the first symptoms to diagnosis, as well as time from diagnosis to staging.…”

UK’s poor performance on cancer survival

“…But on other dimensions of difference, the comparative picture is muddier. An ICBP study of routes to diagnosis for patients with colorectal cancer used standardised surveys of patients and clinicians, combined with linked data, to study 2800 patients in Canada, the UK, Denmark, Sweden, Norway, and Australia 11. Although differences between countries existed in the time it took for patients to see their GP for the first time and in time to onward referral, diagnostic tests, initial diagnosis, and start of treatment, these were not obviously associated with survival differences.…”

Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study

“…Colorectal cancer (CRC) is the third most common cancer worldwide with over 1.8 million new cases registered in 2018 [1]. The majority of symptomatic patients diagnosed with CRC initially consult primary care [2].…”