Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: Evidence from 670 000 patients with cancers of 35 different sites

Y. Zhou*, S. C. Mendonca, G. A. Abel, W. Hamilton, F. M. Walter, S. Johnson, J. Shelton, L. Elliss-Brookes, Sean McPhail, Georgios Lyratzopoulos

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

36 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)24-31
Number of pages8
JournalBritish Journal of Cancer
Volume118
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Bibliographical note

Funding Information:
This project involves data derived from patient-level information collected by the NHS, as part of the care and support of cancer patients. The data are collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England. YZ is a Wellcome Trust Primary Care Clinician Doctoral Fellow, and was supported by an Academic Clinical Fellowship in General Practice funded by Health Education East of England for the duration of this work. GL is supported by the Cancer Research UK Clinician Scientist Fellowship award (C18081/A18180).

Keywords

  • cancer diagnosis
  • cancer epidemiology
  • diagnostic pathway
  • early diagnosis
  • primary care

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