E-poster Presentation 2014 World Cancer Congress

Routes to Diagnosis, a novel English methodology (#647)

Lucy E Elliss-Brookes 1 , Sean McPhail 1 , Alex Ives 2 , Matt Greenslade 2 , Jon Shelton 1 , Sara Hiom 3 , Mike Richards 4
  1. National Cancer Intelligence Network, Public Health England, London, United Kingdom
  2. Knowledge & Intelligence Team (South West), Public Health England, Bristol, United Kingdom
  3. Cancer Research UK, London, United Kingdom
  4. Care Quality Commission, London, United Kingdom


Cancer survival in England is lower than the European average, which has been partly attributed to later stage at diagnosis when there are fewer options for effective treatment.  Understanding the routes taken by patients to their cancer diagnoses and the impact of different routes on patient survival will inform targeted implementation of awareness and early diagnosis initiatives and enable assessment of their success.


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 and personal reasons for delayed diagnosis.


 Routes to Diagnosis uses routinely collected data sources to work backwards through patient pathways to examine the sequence of events that led to a cancer diagnosis. Administrative hospital patient episodes data are combined with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. The method uses the cancer registration diagnosis date as an end-point and then works backwards to identify the likely referral route. Every case of cancer registered in England diagnosed in 2006-2008 (740,000 cases) is categorised into one of eight ‘Routes to Diagnosis’.


The results are fascinating. Different cancer types show substantial differences between the proportions of cases that present by each Route to Diagnosis. Patients presenting via Emergency Routes have significantly lower one-year relative survival. Results show differences in Routes to Diagnosis for tumour type, age, sex, deprivation, geography, ethnicity and year. Relative survival estimates are presented for 1, 3, 6, 9 and 12 month periods.


Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis

  1. Elliss-Brookes L et al. (2012) Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets. BJC 107: 1220-1226