Trends in time to cancer diagnosis around the period of changing national guidance on referral of symptomatic patients: A serial cross-sectional study using UK electronic healthcare records from 2006–17

Price, Sarah; Spencer, Anne; Zhang, Xiaohui; Ball, Susan; Lyratzopoulos, Georgios; Mújica-Mota, Rubén; Stapley, Sal; Ukoumunne, Obioha C; Hamilton, William

doi:10.1016/j.canep.2020.101805

Cited by 32 publications

(41 citation statements)

References 28 publications

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“…Therefore, we limited our analysis to patients over 50 years of age (because cancer is more common in older patients) but were unable to take account of whether symptoms were persistent or unexplained. This limitation applies to other studies based on routine records and using similar methods, 14 but the effect may be to inflate our estimates of potential cancer indicators.…”

Section: Discussionmentioning

confidence: 95%

“…The analysis is based on a comprehensive list of potential cancer indicators, developed and validated by price, which has been used in previous research and is available on request. 14 15 Our analysis included a large number of patients (>126 000) aged 50+ years from a diverse range of backgrounds, and as changes in service provision due to the pandemic have affected the whole country, our findings are likely to be generalisable to other areas of England. As all patients were included, there was no selection bias within practices.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-existing code lists 14 15 were used to identify records of potential cancer indicators associated with a consultation. The indicators were collated from the clinical features of undiagnosed cancer (symptoms, signs, abnormal test results or diagnoses) listed in the National Institute for Health and Care Excellence guidance on the recognition and referral of suspected cancer (NG12), 16 using robust methods.…”

Section: Methodsmentioning

confidence: 99%

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Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

et al. 2021

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ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

et al. 2021

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“…Pre-existing code lists 10,11 were used to identify potential cancer indicators associated with a consultation. Indicators were collated from clinical features of undiagnosed cancer (symptoms, signs, abnormal test results or diagnoses) listed in the National Institute for Health and Care Excellence guidance on the recognition and referral of suspected cancer (NG12) 12 , using robust methods 11 (see appendix 1).…”

Section: Discussionmentioning

confidence: 99%

“…The analysis is based on a comprehensive list of potential cancer indicators, used in previous research. 10,11 Our analysis included large numbers of patients (>350,000) from a diverse range of backgrounds, and as changes due to the pandemic have affected the whole country, ndings are likely to be generalisable across England. Except for ethnicity, missing patient characteristics data were low.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic

Scott

Murphy

Price

et al. 2020

Preprint

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Background In March 2020, the World Health Organisation declared COVID-19 a pandemic.Aim To investigate how the pandemic affected presentation to primary-care with features potentially indicating cancer, and explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations.Design and setting Retrospective cohort study in 21 practices in South-West England.Methods Potential cancer indicators were identified using pre-defined code lists for symptoms, signs, test results and diagnoses. Negative binomial regression models compared reporting of potential cancer indicators in April-July 2020 to April-July 2019. Incidence rate ratios (IRRs), 95% confidence intervals (CIs) and p-values are reported.Results During April-July 2019 and 2020, respectively, 152,447/344,184 (44%) and 123,775/350,966 (35%) patients consulted, with 44,662/344,184 (13%) and 29,150/350,966 (8%) reporting a potential cancer indicator (IRR=0.65, 95%CI 0.62-0.68, p<0.001). Reduced indicator reporting was stable across ethnicity, deprivation and shielding status, was greater in children (0-4 years IRR=0.50, 95%CI 0.46-0.55, p<0.001; 5-17 years IRR=0.45, 95%CI 0.41-0.49, p<0.001) and males (IRR=0.61, 95%CI 0.58-0.64), and less marked in patients with mental health conditions (IRR=0.75, 95%CI 0.72-0.79, p<0.001). Indicator reporting dropped for GP face-to-face consultations (IRR=0.88, 95%CI 0.80-0.97, p=0.011) and increased for remote consultations (IRR=1.22, 95%CI 1.11-1.34, p<0.001), but despite this, remained lower in remote consulting than face-to-face in April-July 2020.Conclusion Patient consulting in general, and for potential cancer indicators specifically, reduced during the first-wave of the COVID-19 pandemic. Remote consulting may be part of the reason for the reduction in reporting of potential cancer indicators, along with the reduced spreading of viral (non-cancer) infections.

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Guideline interval: A new time interval in the diagnostic pathway for symptomatic cancer

Price

Abel

Hamilton

2021

Cancer Epidemiology

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Highlights We describe a new metric to describe the cancer diagnostic pathway: guideline interval. Guideline interval increases less with multimorbidity compared with diagnostic interval. We illustrate guideline interval using UK NICE suspected-cancer referral guidance. Guideline interval is readily modifiable to local policies or updates. Guideline interval is readily adaptable to local suspected-cancer policies.

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Trends in time to cancer diagnosis around the period of changing national guidance on referral of symptomatic patients: A serial cross-sectional study using UK electronic healthcare records from 2006–17

Abstract: Highlights Revised UK suspected-cancer guidance liberalised investigation of patients. Diagnostic interval was longer for patients with newly introduced referral criteria. Scope remains to reduce diagnostic interval further.

Cited by 32 publications

References 28 publications

Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic

Guideline interval: A new time interval in the diagnostic pathway for symptomatic cancer

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