NHS England set out a target that at least 85% of patients should start their first treatment for cancer within 62 days of an urgent GP referral for suspected cancer. However, performance against this target has been poor, and it has not been met since December 2015.
Some patients face waits of more than 104 days between their urgent referral and treatment. The number and percentage of these “long-waiters” have increased over time, particularly during and since the pandemic. NHS guidance states that a review should be carried out for every patient who waits longer than 104 days, to understand and identify whether delays were avoidable. This analysis investigated the demographics and other characteristics of long-waiters, and the reported reasons for delay.
This analysis was conducted in partnership with the National Disease Registration Service, part of NHS England.
The percentage of patients waiting over 104 days to start treatment increased by year from 4.1% in the 2017/2018 financial year to 11.6% in April-September 2022. Patients starting treatment in the first half of the 2022/23 financial year were over three times more likely to have waited 104 days from referral, compared to patients starting treatment in 2017/18, after accounting for demographic factors.
In April-September 2022, the percentage of patients waiting over 104 days was highest for the following cohorts:
Those diagnosed with lower gastrointestinal or urological cancer,
Those living in the most deprived areas,
Those aged 60-69,
Those diagnosed at stage 3, followed by stage 1 and 2,
And those with chronic medical conditions
Looking at where delays occurred in the patient pathway, the longest interval was from referral to a patient being informed of their diagnosis, with a relatively short interval from decision to treat (DTT) to starting treatment.
The most commonly recorded reason for delay for patients who waited over 104 days from referral to treatment was "healthcare provider-initiated delay", which included specific reasons such as inadequate staff capacity or shortage of beds.
Prompt diagnosis and treatment support earlier diagnosis and improved patient experience. This report provides a more in-depth understanding of patients facing the longest waits for cancer care, and the driving factors behind delays.
The recorded reasons for treatment delays suggest that a large number of long-waits are not medically warranted, but due to health system issues. The analysis also suggests that the biggest delays are experienced in the diagnostic period of the patient journey. This indicates that there could be limited workforce and testing capacity driving some of these long-waits.
Lengthy waits disproportionately affected those living in the most deprived areas. This suggests there are inequalities in access to the diagnostic and treatment pathways for cancer, and further investigation of whether these differences are unwarranted would be useful.
It is important to ensure all patients receive timely diagnosis and treatment for cancer. Understanding more about the characteristics of long-waiters can help inform efforts to reduce any unwarranted variation and decrease their frequency overall.
Read the report in fullBreast cancer (PDF, 305 KB) Cancer of unknown primary(PDF, 225 KB) Gynaecological cancer(PDF, 431 KB) Haematological cancer (PDF, 557 KB) Head and neck cancer(PDF, 511 KB) Lower GI cancer(PDF, 424 KB) Lung cancer (PDF, 238 KB) Sarcoma (PDF, 188 KB) Skin cancer(PDF, 323 KB) Upper GI cancer (PDF, 535 KB) Urological cancer(PDF, 537 KB)
Lorna Wills, Scarlett Cartwright-Hughes, Rosie Hinchliffe, Shane Johnson, Sophia Lowes, Fahmina Fardus-Reid, Lucy Ironmonger, Jon Shelton, Lyndsy Ambler, Sam Harrison, Sean McPhail, Lizz Paley, Carolynn Gildea.
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