Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers

Abstract

Background:Evidence is needed about the promptness of cancer diagnosis and associations between its measures.Methods:We analysed data from the National Audit of Cancer Diagnosis in Primary Care 2009–10 exploring the association between the interval from first symptomatic presentation to specialist referral (the primary care interval, or ‘interval' hereafter) and the number of pre-referral consultations.Results:Among 13 035 patients with any of 18 different cancers, most (82%) were referred after 1 (58%) or 2 (25%) consultations (median intervals 0 and 15 days, respectively) while 9%, 4% and 5% patients required 3, 4 or 5+ consultations (median intervals 34, 47 and 97 days, respectively) (Spearman's r=0.70). The association was at least moderate for any cancer (Spearman's r range: 0.55 (prostate)−0.77 (brain)). Patients with cancers with a higher proportion of three or more pre-referral consultations typically also had longer median intervals (e.g., multiple myeloma) and vice versa (e.g., breast cancer).Conclusion:The number of pre-referral consultations has construct validity as a measure of the primary care interval. Developing interventions to reduce the number of pre-referral consultations can help improve the timeliness of cancer diagnosis, and constitutes a priority for early diagnosis initiatives and research.

Quality deviations in cancer diagnosis: prevalence and time to diagnosis in general practice

“…4,27 A recent study from the UK, also based on GP-collected data, reported differences in the number of pre-referral consultations for different cancers, but the study did not investigate why. 28 This study adds important new knowledge to possible reasons why these differences exist.…”

Cancer suspicion in general practice: the role of symptoms and patient characteristics, and their association with subsequent cancer

“…Lyratzopoulos et al 22,23 found that many patients with cancer have several primary care visits before getting a diagnosis of cancer, but that 82% were referred after the first or second consultation; this varied for different types of cancer. Hansen et al 24 found that 3 weeks was the median patient delay.…”

Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

“…For both cancers, 5-year survival is relatively poor, as many are diagnosed at an advanced stage. Diagnostic delays are common, with 29% and 36% of patients with oesophageal and gastric cancer respectively having three or more primary care consultations before diagnosis; [1][2][3] furthermore, 22% and 33% of patients are diagnosed with oesophageal and gastric cancer respectively following emergency presentation. 4 An estimated 600 deaths in the UK from oesophagogastric cancer annually are deemed 'avoidable' by comparison with mean European figures.…”