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

Abstract

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.

Balance on slack line; diagnostic intensity and patient safety during the SARS-CoV-2 pandemic

“…This is parallel to the observation of how some patients with cancer refrain from consultations as reported by Jeppesen and colleagues in the current issue [3]. As the vast majority of patients with cancer are diagnosed following presenting of symptoms to a general practitioner (GP) [25][26][27], a valid starting point to counteract the negative impact of the SARS-CoV-2 pandemic on the diagnosis of cancer is to encourage to contact a GP when experiencing symptoms as advocated in the current issue [2,3,6]. However, encouraging patients to contact their GP when experiencing symptoms suggestive of cancer during a pandemic also raises questions related to optimal methods to ensure adequate health-seeking patterns.…”

The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada

“…This is consistent with data published by the International Cancer Benchmarking Partnership showing that among Canadian provinces, Ontario had the highest survival rates but the longest wait-times. [ 17 ] Taken together, these results imply that organized diagnostic assessment and treatment for lung cancer offers benefits that are clinically important beyond shorter wait times. Furthermore, we have previously reported that patient navigation associated with DAPs successfully mitigates the negative effects of longer wait times on patient experience.…”

“…Since patients diagnosed emergently comprise almost half of all lung cancers, these patients should be further characterized in future work. [ 15 17 18 ]…”

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

“…3 Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway. 4 Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 5 Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway.…”

“…Time to cancer diagnosis, time to treatment and survival rates vary within and between countries. In order to reduce unnecessary and clinically unjustifiable delays, which may be attributable to the patient, doctor or system, several initiatives were implemented across Europe over the last two decades [1][2][3][4][5]. In 2000, the United Kingdom implemented urgent referral pathways and in 2005, the Catalonian Health Service in Spain launched the Cancer Fast-track Programme [6,7].…”