International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data

Nicholson, Brian D; Mant, David; Neal, Richard D; Hart, Nigel; Hamilton, William; Shinkins, Bethany; Rubin, Greg; Rose, Peter W.

doi:10.3399/bjgp16x683449

Cited by 31 publications

(41 citation statements)

References 20 publications

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“…Guidelines may lack efficacy if adherence is low. In their survey of 2795 GPs, NICHOLSON et al [59] reported wide international variation (24-82%) in adherence to lung cancer guidelines, with UK GP adherence significantly lower than that of other geographical regions. Authors acknowledge that lack of available guidelines may have contributed to very low rates of proposed definitive action.…”

Section: Discussionmentioning

confidence: 99%

How long is too long? A scoping review of health system delays in lung cancer

et al. 2018

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Earlier access to lung cancer specialist (LCS) care improves survival, highlighting the need for streamlined patient referral. International guidelines recommend 14-day maximum time intervals from general practitioner (GP) referral to first LCS appointment ("GP-LCS interval"), and diagnosis to treatment ("treatment interval"). We compared time intervals in lung cancer care against timeframe benchmarks, and explored barriers and facilitators to timely care.We conducted a scoping review of literature from MEDLINE, Embase, Scopus and hand searches. Primary end-points were GP-LCS and treatment intervals. Performance against guidelines and factors responsible for delays were explored. We used descriptive statistics and nonparametric Wilcoxon rank sum tests to compare intervals in studies reporting fast-track interventions.Of 1343 identified studies, 128 full-text articles were eligible. Only 33 (26%) studies reported GP-LCS intervals, with an overall median of 7 days and distributions largely meeting guidelines. Overall, 52 (41%) studies reported treatment intervals, with a median of 27 days, and distributions of times falling short of guidelines. There was no effect of fast-track interventions on reducing time intervals. Lack of symptoms and multiple procedures or specialist visits were suggested causes for delay.Although most patients with lung cancer see a specialist within a reasonable timeframe, treatment commencement is often delayed. There is regional variation in establishing timeliness of care.

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Section: Discussionmentioning

confidence: 99%

How long is too long? A scoping review of health system delays in lung cancer

et al. 2018

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“…Second, data prospectively documenting the degree of implementation could for each revision be extracted from the clinical DBCG database. In contrast, implementation of guidelines is frequently evaluated retrospectively using questionnaires [35]. Some limitations should be considered when interpreting our study.…”

Section: Discussionmentioning

confidence: 99%

The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007–2016

et al. 2017

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“…In the past 68 (27) 49 (25) 42 (21) 74 (26) 83 (41) 133 (46) 59 283 3124 60661 (31) <0.001 § † II 27 (13) 36 (14) 32 (16) 33 (17) 26 (9) 19 938 1311 55 647 (23) 274 (13) <0.001 ¶ ‡ III 64 (30) 57 (23) 56 (28) 59 (30) 84 (29) 48 (24) 54 (19) 40 (19) 5 619 (9) 486 (23) IV 62 (29) 80 (32) 50 (25) 62 (31) 94 (33) 48 (24) 54 (19) 94 453 313 (6) 560 ( (39) 68 (27) 76 (38) 72 (36) 114 (40) 81 (40) 98 (34) 70 3341 4729…”

Section: Open Accessunclassified

“…Categorising presenting symptoms into indicative or not was done pragmatically as existing guidelines for lung cancer investigation vary across ICBP jurisdictions. 36 In Norway and Victoria, a small sample size and restriction of eligibility to only surgical patients, respectively, made comparison difficult. Nonetheless, significant differences in these two jurisdictions compared with Wales were largely limited to the treatment interval alone.…”

Section: Open Accessmentioning

confidence: 99%

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

et al. 2019

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ObjectiveDifferences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.DesignNewly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.ParticipantsConsecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.Primary and secondary outcome measuresInterval lengths (days; primary), routes to diagnosis and symptoms (secondary).ResultsWith the exception of Denmark (−49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012–2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (−11 days) than Wales (20 days); Sweden had shorter (−20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (−13), Manitoba (−11), England (−9) and Northern Ireland (−4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.ConclusionThere are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.

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International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data

Abstract: BackgroundVariation in cancer survival persists between comparable nations and appears to be due, in part, to primary care practitioners (PCPs) having different thresholds for acting definitively in response to cancer-related symptoms.

Cited by 31 publications

References 20 publications

How long is too long? A scoping review of health system delays in lung cancer

How long is too long? A scoping review of health system delays in lung cancer

The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007–2016

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

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