40 days is average for cancer diagnosis in England

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The average time for a patient in England to be diagnosed with cancer is 40 days, rather than the target 28 days, a study suggests.

Health officials have set a target for all cancer patients to be diagnosed within 28 days by 2020. But the study found that in 2014 the median number of days from first relevant presentation to the date of diagnosis was 40 days. This ranged from 15 days to 86 days, according to the research.

Researchers, led by Ruth Swann, senior analyst for Public Health England’s National Cancer Registration and Analysis Service, examined data on more than 17,000 patients diagnosed with cancer in 2014. They found that GPs referred these patients on to specialists within five days on average.

Patients with breast cancer had the shortest time to diagnosis, waiting on average just 14 days. But those with prostate cancer had a median time to diagnosis of 55.5 days. The authors found that the time from referral to being told the diagnosis of cancer exceeded 28 days in 54% of patients. This included 19% of patients with breast cancer having to wait longer than 28 days compared with 74% of melanoma patients.

For one in five patients (22%) the GP considered there to be an “avoidable delay” in the patient receiving their diagnosis. Delays were most frequently attributed to the patient, primary or secondary care clinician, and system factors.

The report says NHS England has set an ambition for all people to be diagnosed with cancer, or that cancer will be excluded, within 28 days of them being referred by their GP by 2020. The authors suggest their finding may provide pointers to where efforts will be best directed to achieve this standard.

Dr Jodie Moffat, from Cancer Research UK, said: “The study pinpoints why delays may be happening. The message couldn’t be clearer – too many patients have waited far too long for diagnostic tests or getting the results back.

“This must change. Waiting for a diagnosis is an exceptionally anxious time for patients, so it’s vital that no one has to wait longer than necessary.

“Diagnostic services need more staff to provide tests for patients, which should speed things up in the future. There is no magic bullet for earlier diagnosis.”

An NHS England spokesperson is quoted in the report as saying: “In the three years since these 2014 figures were collected, the NHS has published a national cancer strategy and, thanks to improved NHS care, an extra 2,000 people now survive cancer each year. Last year, over 1.7m people were urgently referred by their GP, half a million more than three years ago when the data in this report were collected.”

Dr Jem Rashbass, cancer lead at Public Health England said: “Cancer claims too many lives every year and we know that one of the biggest challenges we face is detecting cancer earlier.”

Background: Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this.
Aim: To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit.
Design and setting: Clinical audit of cancer diagnosis in general practices in England.
Method: Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management.
Results: Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more.
Conclusion: The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer.

Ruth Swann, Sean McPhail, Jana Witt, Brian Shand, Gary A Abel, Sara Hiom, Jem Rashbass, Georgios Lyratzopoulos, Greg Rubin

The Independent report
British Journal of General Practice abstract

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