Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015–2016

Abstract

Background Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion. Methods All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015–2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity. Results From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70–2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00–1.54) and lung (OR = 1.52, 95%CI: 1.16–1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients. Conclusions The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.

Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway

“…The study population included all patients with a colorectal (ICD-10 code C18–20) cancer diagnosis registered at the CRN between 1 January 2015 and 31 December 2016. As described elsewhere, information from the NPR was linked to identify which patients were included in a CPP, the patient’s level of co-existing diseases (i.e., comorbidities) and all registered episodes from the specialist health care [ 9 ]. Information about the patient’s SES, measured through household income and education, was obtained from Statistics Norway.…”

“…As described elsewhere, date of diagnosis was defined as the date of the first histologically verified diagnosis registered at the CRN, which most often was based on a biopsy [ 9 ]. For patients whose tumour was not morphologically verified, the date of diagnosis was set as the date from the clinical notification form.…”

“…With the implementation of CPPs, cancer pathway coordinators were introduced to coordinate referrals, plan appointments, and provide information to the patients until the first specialist consultation. In Norway, it has been shown that over 80% of all colorectal cancer patients were included in a CPP during 2015–2016 [ 9 ]. A recent study from Norway showed that the waiting time from diagnosis to surgery for colorectal cancer patients diagnosed from 2007 to 2016 remained around 21 days, while time to start of radiotherapy has decreased by two weeks to 34 days [ 10 ].…”

Recognising Colorectal Cancer in Primary Care

“…Recognising challenges in diagnosing cancers with varied symptomatology, different diagnostic pathways have been pioneered in Denmark, with urgent referrals for both alarm symptoms and serious, non-specific symptoms (GP triage is required for the latter—with direct access to investigations) and the use of diagnostic centres (also with direct access) for vague symptoms [ 111 ]. Similar approaches have been adopted in Norway and Sweden [ 112 , 113 ], and tested in England as part of the “Accelerate, Coordinate, Evaluate” (ACE) programme [ 114 – 116 ]. Informed by ACE results, the 2019 National Health Service (NHS) long-term plan stipulates the creation of Rapid Diagnostic Centres (RDCs).…”

The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care

“…In 2008, Denmark was the first country to standardize and expedite diagnostic paths through 29 cancer care pathways that define investigations and define maximal lead times. Similar systems have since 2015 been implemented also in Norway and Sweden [11,12]. The organizations and responsibilities for the clinical cancer registry initiatives differ somewhat between Denmark, Norway and Sweden.…”