Abstract
Background:In England, ‘fast-track’ (also known as ‘two-week wait’) general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups.Methods:We examined data from 669 220 patients with 35 cancers diagnosed in 2006–2010 following either fast-track or ‘routine’ primary-to-secondary care referrals using ‘Routes to Diagnosis’ data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer.Results:There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer.Conclusions:Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for ‘alarm’ symptoms are needed to improve diagnostic timeliness.
Highlights
In England, ‘fast-track’ general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines
In England, dedicated referral pathways supported by national clinical guidelines have been in existence since 1999 to expedite referral for the diagnostic evaluation of patients with suspected cancer in order to reduce the length of diagnostic intervals after patients present to their general practitioner (GP) (NICE, 2005)
Diagnostic delays may occur both because of patient and system factors, in this paper we focus on variation in the type of GP referral route, as a factor that can affect the length of the post-presentation intervals
Summary
We examined data from 669 220 patients with 35 cancers diagnosed in 2006–2010 following either fast-track or ‘routine’ primary-to-secondary care referrals using ‘Routes to Diagnosis’ data. There were sex, age and deprivation differences in the odds of fast-track referral (Po0.013) that varied in their size and direction for patients with different cancers (Po0.001). ‘Diagnostic routes’ represent care pathways to diagnosis. They are assigned using an algorithm based on linked data from cancer registration, Hospital Episodes Statistics, National Cancer Waiting Times and National Health Service Cancer Screening Programmes (for breast, bowel and cervical cancers) as previously described (Elliss-Brookes et al, 2012). We did so because we were a priori interested in factors that make the suspicion of cancer diagnosis either harder or easier once patients have consulted with a GP, outside of circumstances where an emergency hospital referral is needed
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