We analysed data from the National Cancer Diagnosis Audit (NCDA) for patients diagnosed with cancer in England in 2014. We wanted to understand the frequency, nature and impact of avoidable delays. This work was carried out in partnership with the National Disease Registration Service and the National Cancer Diagnosis Audit Methodology Group.
Delays in diagnosis are important to minimise because timely diagnosis supports early stage diagnosis and improved cancer outcomes.
Among 17,000 cancer patients, 24% were deemed to have experienced an avoidable delay to their diagnosis. These patients waited an average of 92 days between their first consultation and their diagnosis compared to 30 days for those without avoidable delays.
Of all the avoidable delays:
13% occurred pre-consultation
49% in primary care
38% in secondary care
Avoidable delays were predominantly attributed to the clinician in primary care and to the healthcare system in secondary care.
Most frequently, avoidable delays occurred during the test request / performance phase of the diagnostic process, and in primary care led investigations.
About half of patients who experienced a prolonged primary care or diagnostic interval were not deemed by the GP to have had an avoidable delay.
Avoidable delays were more likely in patients with greater number of comorbidities, certain cancer types (pancreatic, colon, rectal, and stomach), and when referrals were not made through the ‘suspected cancer’ Two Week Wait pathway.
More deprived patients were at greater risk of avoidable delay due to delayed help-seeking, but less likely to experience delays at the test request stage.
Delays to diagnosis increases the risk of poorer outcomes for patients. Understanding the frequency and causes of avoidable delays in diagnosis can guide improvement initiatives and help to understand the implications for patient outcomes.
Read in full on the Science Direct websiteRuth Swann, Georgios Lyratzopoulos, Greg Rubin, Elizabeth Pickworth, Sean McPhail.
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