We analysed data from the National Cancer Diagnosis Audit (NCDA) for patients diagnosed with cancer in England during 2014. We wanted to understand how cancers are diagnosed in primary care and to establish baseline measures for future audits. This work was carried out in partnership with the National Disease Registration Service and the National Cancer Diagnosis Audit Methodology Group.
The National Cancer Data Audit (NCDA) was a UK-wide programme which ran in 2014 and 2018 with the aim of helping us to better understand pathways to cancer diagnosis in primary care and where improvements could be made to achieve better cancer outcomes.
Continual improvements in diagnostic processes are needed to minimise delays and ensure people receive a timely cancer diagnosis.
Among 17,000 cancer patients in 2014:
26% of patients had three or more GP consultations. Multiple (>3) consultations were most commonly due to symptoms suggesting a different initial diagnosis (11%) or comorbidity ‘blurring the picture’ (5%).
Around 52% of patients were referred via the Two Week Wait (TWW) route, though this varied by cancer site ranging from 9% (brain cancer) to 78% (endometrial cancer).
Emergency referrals accounted for 17%, ranging from around 1% (melanoma) to 65% (brain cancer). Of these, 48% were self-referrals to A&E/hospital, and 47% were GP or out-of-hours referrals.
The average time from first presentation to referral was 5 days, but 8% of patients waited longer than 90 days.
Overall, the average time from first presentation to the date of diagnosis was 40 days, ranging from 14 days for breast cancer to around 56 days for prostate cancer.
54% of patients waited more than 28 days from referral to being told the diagnosis of cancer. This ranged from 19% for breast cancer to 74% for melanoma.
For 22% of patients, the GP considered there to be an avoidable delay in the patient receiving their diagnosis. These were attributed to patient (26%), clinician (28%), or system (34%) factors.
At least one primary care-led investigation was carried out for 45% of patients ranging from 3% for breast cancer to 76 % for prostate cancer.
Safety netting was recorded for 44% of patients, with substantial variation by cancer site.
The findings highlight opportunities to improve diagnostic pathways and provide a baseline for future audit of the impact of NICE’s 2015 guidance on the management and referral of suspected cancer.
Ruth Swann, Sean McPhail, Jana Witt, Brian Shand, Gary A Abel, Sara Hiom, Jem Rashbass, Georgios Lyratzopoulos, Greg Rubin.
If you have any comments, questions or feedback, please reach out to our team.
