Abstract
BackgroundThere is substantial variation in the use of urgent suspected cancer referral (2-week wait [2WW]) between practices.AimTo examine the change in use of 2WW referrals in England over 10 years (2009/2010 to 2018/2019) and the practice and population factors associated with cancer detection.Design and settingRetrospective cross-sectional study of English general practices and their 2WW referral and Cancer Waiting Times database detection data (all cancers other than non-melanoma skin cancers) from 2009/2010 to 2018/2019.MethodA retrospective study conducted using descriptive statistics of changes over 10 years in 2WW referral data. Yearly linear regression models were used to determine the association between cancer detection rates and quintiles of practice and population characteristics. Predicted cancer detection rates were calculated, as well as the difference between lowest to highest quintiles.ResultsOver the 10 years studied there were 14.89 million 2WW referrals (2.24 million in 2018/2019), and 2.68 million new cancer diagnoses, of which 1.26 million were detected following 2WW. The detection rate increased from 41% to 52% over the time period. In 2018/2019 an additional 66 172 cancers were detected via 2WW compared with 2009/2010. Higher cancer detection via 2WW referrals was associated with larger practices and those with younger GPs. From 2016/2017 onwards more deprived practice populations were associated with decreased cancer detection.ConclusionFrom 2009/2010 to 2018/2019 2WW referrals increased on average by 10% year on year. The most consistent association with higher cancer detection was found for larger practices and those with younger GPs, though these differences became attenuated over time. The more recent association between increased practice deprivation and lower cancer detection is a cause for concern. The COVID-19 pandemic has led to significant impacts on 2WW referral activity and the impact on patient outcomes will need to be studied.
Highlights
Most people with cancer present symptomatically to primary care,[1] the diagnosis of cancer in general practice is not straightforward.[2,3] International variations in cancer survival have been partly attributed to healthcare system differences in primary care,[4] whether systems with prominent primary care ‘gatekeeping’ may result in longer diagnostic intervals and poorer outcomes for patients with cancer.[5,6]Concerns about diagnostic delays led to the implementation of urgent referral pathways in England.[7]
The most consistent association with higher cancer detection was found for larger practices and those with younger GPs, though these differences became attenuated over time
The COVID-19 pandemic has led to significant impacts on 2WW referral activity and the impact on patient outcomes will need to be studied
Summary
Most people with cancer present symptomatically to primary care,[1] the diagnosis of cancer in general practice is not straightforward.[2,3] International variations in cancer survival have been partly attributed to healthcare system differences in primary care,[4] whether systems with prominent primary care ‘gatekeeping’ may result in longer diagnostic intervals and poorer outcomes for patients with cancer.[5,6]Concerns about diagnostic delays led to the implementation of urgent referral pathways in England.[7]. Most people with cancer present symptomatically to primary care,[1] the diagnosis of cancer in general practice is not straightforward.[2,3] International variations in cancer survival have been partly attributed to healthcare system differences in primary care,[4] whether systems with prominent primary care ‘gatekeeping’ may result in longer diagnostic intervals and poorer outcomes for patients with cancer.[5,6]. For many cancers there is good evidence that the time to diagnosis and treatment is reduced for patients who are referred urgently.[10,11] There are significant variations in the use of 2WW between practices,[12] with referral route an important potential predictor of time to diagnosis.[13,14]. There is substantial variation in the use of urgent suspected cancer referral (2-week wait [2WW]) between practices
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