For which cancers might patients benefit most from expedited symptomatic diagnosis? Construction of a ranking order by a modified Delphi technique.

Willie Hamilton,Sally Stapley,Greg Rubin,Christine Campbell,Richard D. Neal,Georgios Lyratzopoulos

doi:10.1186/s12885-015-1865-x

Abstract

BackgroundThis study aimed to answer the question ‘for which cancers, in a symptomatic patient, does expediting the diagnosis provide an improvement in mortality and/or morbidity?’MethodsAn initial ranking was constructed from previous work identifying ‘avoidable deaths’ for 21 common cancers in the UK. In a two-round modified Delphi exercise, 22 experts, all experienced across multiple cancers, used an evidence pack summarising recent relevant publications and their own experience to adjust this ranking. Participants also answered on a Likert scale whether they anticipated mortality or morbidity benefits for each cancer from expedited diagnosis.ResultsSubstantial changes in ranking occurred in the Delphi exercise. Finally, expedited diagnosis was judged to provide the greatest mortality benefit in breast cancer, uterine cancer and melanoma, and least in brain and pancreatic cancers. Three cancers, prostate, brain and pancreas, attracted a median answer of ‘disagree’ to whether they expected mortality benefits from expedited diagnosis of symptomatic cancer.ConclusionsOur results can guide future research, with emphasis given to studying interventions to improve symptomatic diagnosis of those cancers ranked highly. In contrast, research efforts for cancers with the lowest rankings could be re-directed towards alternative avenues more likely to yield benefit, such as screening or treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1865-x) contains supplementary material, which is available to authorized users.

Highlights

This study aimed to answer the question ‘for which cancers, in a symptomatic patient, does expediting the diagnosis provide an improvement in mortality and/or morbidity?’ Methods: An initial ranking was constructed from previous work identifying ‘avoidable deaths’ for 21 common cancers in the United Kingdom (UK)
It is still considered axiomatic that avoiding delay in symptomatic cancer diagnosis is beneficial, in reducing mortality and morbidity, providing symptom relief and possible improvements in
There is an element of nihilism with cure considered unlikely whatever the time to diagnosis

Summary

Introduction

This study aimed to answer the question ‘for which cancers, in a symptomatic patient, does expediting the diagnosis provide an improvement in mortality and/or morbidity?’ Methods: An initial ranking was constructed from previous work identifying ‘avoidable deaths’ for 21 common cancers in the UK. Participants answered on a Likert scale whether they anticipated mortality or morbidity benefits for each cancer from expedited diagnosis. It is still considered axiomatic that avoiding delay in symptomatic cancer diagnosis is beneficial, in reducing mortality and morbidity, providing symptom relief and possible improvements in Patients certainly value early diagnosis of cancer [6]. There is an element of nihilism with cure considered unlikely whatever the time to diagnosis

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Methods

Results

Conclusion