How might healthcare systems influence speed of cancer diagnosis: A narrative review

Abstract

Striking differences exist in outcomes for cancer between developed countries with comparable healthcare systems. We compare the healthcare systems of 3 countries (Denmark, Norway, Sweden), 3 UK jurisdictions (England, Wales and Northern Ireland), 3 Canadian provinces (British Columbia, Manitoba, Ontario) and 2 Australian states (New South Wales, Victoria) using a framework which assesses the possible contribution of primary care systems to a range of health outcomes, drawing on key characteristics influencing population health.For many of the characteristics we investigated there are no significant differences between those countries with poorer cancer outcomes (England and Denmark) and the rest. In particular, regulation, financing, the existence of patient lists, the GP gatekeeping role, direct access to secondary care, the degree of comprehensiveness of primary care services, the level of cost sharing and the type of primary care providers within healthcare systems were not specifically and consistently associated with differences between countries. Factors that could have an influence on patient and professional behaviour, and consequently contribute to delays in cancer diagnosis and poorer cancer outcomes in some countries, include centralisation of services, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems.It was not possible to establish a causal correlation between healthcare system characteristics and cancer outcomes. Further studies should explore in greater depth the associations between single health system factors and cancer outcomes, recognising that in complex systems where context is all-important, it will be difficult to establish causal relationships. Better understanding of the interaction between healthcare system variables and patient and professional behaviour may generate new hypotheses for further research.

Reproductive cancers among South African Black men: A scoping review protocol

“…Fundamentally, this victim blaming stance point out several questions about various assumptions [8]. For instance, the marginalisation of traditional health beliefs in treatment adherence management, assuming that prostate cancer is but one disease, and also assuming that men constitute a homogenous group of people whose actions or inactions are preserved across generations, race and time [9][10][11].…”

Cost Analysis of Breast Cancer Diagnostic Assessment Programs

“…Those factors include limited access to diagnostic tests; problems identifying, communicating with, and referring to specialists; and limited availability of human and technical resources 3,4 . Centralized diagnostic assessment programs (daps) appear to overcome those challenges and minimize diagnostic delays by improving access to specialist care [5][6][7] . A dap can lessen the time from first referral to specialist visit and the time to first treatment, and can improve patient satisfaction with services and personal care received 8,9 .…”

“…Guidelines for implementing daps are available 9 , and daps of various types have emerged to coordinate and expedite cancer diagnostic services [5][6][7] . Some ensure that patients are seen concurrently or consecutively by a multidisciplinary team of specialists, and others include navigators to coordinate the patient's diagnostic process and to provide information and support to patients 5,6 .…”

What health care system delays reveal about inequalities in breast cancer medicine and global health

“…Currently, ascertaining a direct causal relation between differences in the delivery of care and differences in cancer outcomes is difficult. [1][2][3] Nevertheless, it is important to develop a clearer understanding of the factors that influence the receipt of breast cancer treatment. There are several reasons for this: 1) advances in the effectiveness of treatment are likely to make differences in the time to diagnosis and treatment more significant; 2) a smooth progression of care may improve the experience of patients, which, in itself, is a key aspect of the delivery of care; and 3) the growth of multidisciplinary centers worldwide will intensify the need for coordination among diverse practitioners and departments.…”

“…It appears that socioeconomic resources have less impact on cancer outcomes in this setting than referral times or the coordination of services, mirroring some of the previous findings from studies in higher resource settings. 1,13 Those studies suggest that rigorous assessments of system-level inequalities will require a combination of qualitative and quantitative approaches in the analysis of delay. The findings from Unger-Saldaña et al contribute to a growing consensus in cancer policy that the efficient and equitable operation of health care systems will require improved planning and communication.…”