Abstract

BackgroundCancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion.MethodsAll patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015–2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity.ResultsFrom 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70–2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00–1.54) and lung (OR = 1.52, 95%CI: 1.16–1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients.ConclusionsThe national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.

Highlights

  • Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients

  • In 2015–2016 the proportions of cases in a CPP ranged from 67.8% among prostate cancer to 93.2% for breast cancer, with colorectal and lung cancers being around 80.0%

  • Year of diagnosis The proportion of colorectal, lung, breast and prostate cancer patients included in a CPP increased from 75.0% in 2015 to 83.9% in 2016 (Table 1)

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Summary

Introduction

Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. In 2000, the United Kingdom implemented urgent referral pathways and in 2005, the Catalonian Health Service in Spain launched the Cancer Fast-track Programme [6, 7]. The aim of both programs was to reduce the time that elapsed between suspicion of cancer and the start of initial treatment. In the period 2007–2008 Denmark implemented cancer patients pathways (CPPs) to reduce waiting times and regional variation, and to improve cancer survival [8, 9]. The Danish initiative strongly influenced the implementation of CPPs in both Sweden in 2015–2018 and Norway in 2015 [10, 11]

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