Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients
A new study recently published in Cancers, found that over one-quarter of bladder and kidney cancer patients who met NICE fast-track referral guidelines did not receive a timely diagnosis, suggesting that opportunities exist to improve timely referral.
In England, patients with alarm features (symptoms and/or test results) of cancer should be assessed by a specialist within 14 days based on national guidelines. However, it is not known how quickly these patients are actually diagnosed. We therefore examined how quickly patients who met these fast-track referral criteria were diagnosed, using bladder and kidney cancer patients as exemplars.
This study involved CanTest researchers and others from the Universities of Cambridge, UCL, Exeter and Baylor College of Medicine in the USA and used data from linked primary care (Clinical Practice Research Datalink, CPRD) and the Cancer Registry databases. Women with bladder and kidney cancer in general experience a longer time to diagnosis than men and are more likely to be diagnosed following a visit to the emergency room. We were particularly interested to find out whether this gender inequality also existed among patients attending primary care with features that warranted a fast-track referral.
We found that more than one-quarter of the patients who qualified for fast-track referral did not receive a timely diagnosis. ‘Timely’ is defined as the time from qualifying for fast-track referral in primary care to diagnosis being within 90 days. Patients with recurrent urinary tract infections (UTIs) had the longest time to diagnosis (median diagnostic interval of 83 days, range 43-151 days) and those with visible blood in their urine (haematuria) had the shortest time to diagnosis (median 50 days, range 30-79).
After adjustment, the factors associated with greater odds of a non-timely diagnosis were:
- Recurrent UTIs
- Being in the youngest or oldest age group
- Female sex
- Diagnosis of kidney and upper tract urothelial cancer.
Our findings suggest that opportunities exist to improve timely referral in patients with bladder and kidney cancer. A number of factors contribute to non-timely referral of these patients. Risk prediction tools, in-consultation alerts and post-consultation triggers may help clinicians minimise the impact of some of these factors. This could enable an important step towards improving the overall gender inequality seen in diagnostic timeliness of urological cancer patients.