Background:
Cancer survival in England is lower than the European average, which has been partly attributed to later stage at diagnosis. Understanding the impact of different routes to diagnosis on patient survival informs targeted implementation of awareness & early diagnosis initiatives and enables assessment of their success.
Aim:
This innovative study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service & personal reasons for delayed diagnosis. Initial results have influenced the direction and focus of the national cancer agenda with the routine monitoring of Emergency Presentations (EPs) now a high priority.
Methods:
Administrative hospital patient episodes data are combined with Cancer Waiting Times, cancer screening and cancer registration data. The method uses the diagnosis date as an end-point and then works backwards to identify the likely referral route. Every case of cancer diagnosed in England in 2006-2010 (1,272,584 cases) is categorised into one of 8 Routes to Diagnosis.
Results:
Most cancers were diagnosed through one of EP (23%), Two Week Wait (27%) or GP Referral (27%) with the other five routes making up 23%. These proportions vary considerably by cancer, with a high percentage of EPs in cancers of the brain (63%), pancreatic (48%) & lung cancer (38%), compared to melanoma (3%) & breast cancer (5%). The proportion of EPs also increases with increasing age. The substantially lower relative survival in the EP Route compared to other routes indicates that this distinction is of high clinical significance.
Conclusions:
Routes to Diagnosis can be used to explore reasons for delayed diagnosis and identify areas for further research. Understanding the reasons behind the difference in EP rates will help commissioners to raise awareness of early detection & treatment of cancer in high risk patient groups including the elderly.