Elsevier

Cancer Epidemiology

Volume 61, August 2019, Pages 111-118
Cancer Epidemiology

Establishing population-based surveillance of diagnostic timeliness using linked cancer registry and administrative data for patients with colorectal and lung cancer

https://doi.org/10.1016/j.canep.2019.05.010Get rights and content
open access

Highlights

  • We developed a new methodology for measuring the secondary care diagnostic interval.

  • Secondary care diagnostic interval was calculated for 95% of cancers.

  • This interval varied by route to diagnosis, stage and comorbidities.

  • Routine GP referrals and outpatient routes had longest intervals.

  • Intervals decreased by advancing stage, within each route to diagnosis.

Abstract

Background

Diagnostic timeliness in cancer patients is important for clinical outcomes and patient satisfaction but, to-date, continuous monitoring of diagnostic intervals in nationwide incident cohorts has been impossible in England.

Methods

We developed a new methodology for measuring the secondary care diagnostic interval (SCDI - first relevant secondary care contact to diagnosis) using linked cancer registration and healthcare utilisation data. Using this method, we subsequently examined diagnostic timeliness in colorectal and lung cancer patients (2014–15) by socio-demographic characteristics, diagnostic route and stage at diagnosis.

Results

The approach assigned SCDIs to 94.4% of all incident colorectal cancer cases [median length (90th centile) of 25 (104) days] and 95.3% of lung cancer cases [36 (144) days]. Advanced stage patients had shorter intervals (median, colorectal: stage 1 vs 4 - 34 vs 19 days; lung stage 1&2 vs 3B&4 - 70 vs 27 days). Routinely referred patients had the longest (colorectal: 61, lung: 69 days) and emergency presenters the shortest intervals (colorectal: 3, lung: 14 days). Comorbidities and additional diagnostic tests were also associated with longer intervals.

Conclusion

This new method can enable repeatable nationwide measurement of cancer diagnostic timeliness in England and identifies actionable variation to inform early diagnosis interventions and target future research.

Keywords

Secondary care
Lung cancer
Colorectal cancer
Diagnostic intervals
Early detection of cancer
Early diagnosis
England
Population-based cancer registries

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