Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study.
Henrik Møller,Henrik Møller,Carolynn Gildea,David Meechan,Greg Rubin,Thomas Round,Peter Vedsted +6 more
TLDR
Use of the urgent referral pathway could be efficacious and general practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer.Abstract:
Objective To assess the overall effect of the English urgent referral pathway on cancer survival. Setting 8049 general practices in England. Design Cohort study. Linked information from the national Cancer Waiting Times database, NHS Exeter database, and National Cancer Register was used to estimate mortality in patients in relation to the propensity of their general practice to use the urgent referral pathway. Participants 215 284 patients with cancer, diagnosed or first treated in England in 2009 and followed up to 2013. Outcome measure Hazard ratios for death from any cause, as estimated from a Cox proportional hazards regression. Results During four years of follow-up, 91 620 deaths occurred, of which 51 606 (56%) occurred within the first year after diagnosis. Two measures of the propensity to use urgent referral, the standardised referral ratio and the detection rate, were associated with reduced mortality. The hazard ratio for the combination of high referral ratio and high detection rate was 0.96 (95% confidence interval 0.94 to 0.99), applying to 16% (n=34 758) of the study population. Patients with cancer who were registered with general practices with the lowest use of urgent referral had an excess mortality (hazard ratio 1.07 (95% confidence interval 1.05 to 1.08); 37% (n=79 416) of the study population). The comparator group for these two hazard ratios was the remaining 47% (n=101 110) of the study population. This result in mortality was consistent for different types of cancer (apart from breast cancer) and with other stratifications of the dataset, and was not sensitive to adjustment for potential confounders and other details of the statistical model. Conclusions Use of the urgent referral pathway could be efficacious. General practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer.read more
Citations
More filters
Journal ArticleDOI
Improving early diagnosis of symptomatic cancer
TL;DR: This Review examines expedited diagnosis of cancer from four perspectives, focusing on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting have all occurred during a period of considerable national policy change.
Journal ArticleDOI
Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries
Marie Louise Tørring,Peter Murchie,William Hamilton,Peter Vedsted,Magdalena Esteva,Marianne Djernes Lautrup,Marcy Winget,Greg Rubin +7 more
TL;DR: This study provides evidence that longer diagnostic intervals are associated with more advanced CRC, and cannot define a specific ‘safe’ waiting time as the length of the primary care interval appears to have negative impact from day one.
Journal ArticleDOI
Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites.
Yin Zhou,Silvia C Mendonca,Gary A. Abel,William Hamilton,Fiona M Walter,S. Johnson,J. Shelton,Lucy Elliss-Brookes,Sean McPhail,Georgios Lyratzopoulos,Georgios Lyratzopoulos,Georgios Lyratzopoulos +11 more
TL;DR: Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups.
Journal ArticleDOI
Rural-Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer
Rebecca J Bergin,Rebecca J Bergin,Jon Emery,Ruth Bollard,Alina Zalounina Falborg,Henry Jensen,David Weller,Usha Menon,Peter Vedsted,Robert J. Thomas,K. Whitfield,Victoria White,Victoria White +12 more
TL;DR: Rural residence was associated with longer total intervals for colorectal but not breast cancer; with most disparities postpresentation.
Journal ArticleDOI
Recognizing Gynecological Cancer in Primary Care: Risk Factors, Red Flags, and Referrals.
TL;DR: Key risk factors are outlined, prevention and screening strategies are briefly discussed, and practical guidance is offered on the recognition of symptoms and signs and the investigation and referral of women with suspected cancer are offered.
References
More filters
Journal ArticleDOI
Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review
Richard D Neal,Puvan Tharmanathan,Nafees Ud Din,Samuel Cotton,Julia Fallon-Ferguson,William Hamilton,Annie Hendry,Maggie Hendry,Ruth Lewis,Una Macleod,Elizabeth Mitchell,M Pickett,Tekendra K Rai,K Shaw,Nicholas Stuart,Marie Louise Tørring,Clare Wilkinson,Briony Williams,Nefyn Williams,Jon Emery +19 more
TL;DR: This is the first review encompassing many cancer types, and it is demonstrated that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
Journal ArticleDOI
Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets
TL;DR: Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients to enhance understanding of and explore possible reasons for delayed diagnosis.
Journal ArticleDOI
The influence on survival of delay in the presentation and treatment of symptomatic breast cancer.
TL;DR: Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage, however, within individual stages, longer delay had no adverse impact on survival.
Journal ArticleDOI
Tumor progression in waiting time for radiotherapy in head and neck cancer.
TL;DR: A negative impact of waiting time in patients with squamous-cell carcinoma of the head and neck is shown, with the majority of the patients developed significant signs of tumor progression within an average time of 4 weeks.
Journal ArticleDOI
Delay in diagnosis: the experience in Denmark.
TL;DR: In future, fast-track diagnosis and treatment will be provided for suspected cancers and access to general diagnostic investigations will be improved.
Related Papers (5)
Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review
Richard D Neal,Puvan Tharmanathan,Nafees Ud Din,Samuel Cotton,Julia Fallon-Ferguson,William Hamilton,Annie Hendry,Maggie Hendry,Ruth Lewis,Una Macleod,Elizabeth Mitchell,M Pickett,Tekendra K Rai,K Shaw,Nicholas Stuart,Marie Louise Tørring,Clare Wilkinson,Briony Williams,Nefyn Williams,Jon Emery +19 more
The expanding role of primary care in cancer control
Greg Rubin,Annette J. Berendsen,S Michael Crawford,Rachel Dommett,Craig C. Earle,Jon Emery,Tom Fahey,Luigi Grassi,Eva Grunfeld,Sumit Gupta,Willie Hamilton,Sara Hiom,David J. Hunter,Georgios Lyratzopoulos,Una Macleod,Robert Mason,Geoffrey Mitchell,Richard D Neal,Michael D Peake,Martin Roland,Bohumil Seifert,Jeff Sisler,Jonathan Sussman,Stephen H. Taplin,Peter Vedsted,Teja Voruganti,Fiona M Walter,Jane Wardle,Eila Watson,David Weller,Richard C. Wender,Jeremy Whelan,James A. Whitlock,Clare Wilkinson,Niek J. de Wit,Camilla Zimmermann +35 more
Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data
Michel P Coleman,David Forman,Heather Bryant,John Butler,Bernard Rachet,Camille Maringe,Ula Nur,Elizabeth Tracey,Michael Coory,Juanita Hatcher,Colleen E. McGahan,D Turner,Loraine D. Marrett,ML Gjerstorff,Tom Børge Johannesen,Jan Adolfsson,Mats Lambe,Mats Lambe,Glenda Lawrence,David Meechan,Eva Morris,Richard Middleton,John Steward,Michael Richards +23 more