Exploring the impact of the NICE guidelines for suspected cancers on diagnostic interval and resource use within GP practices

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Project Summary

The aims of this research are to:

  1. Explore changes over the period 2000-2015 in: (a) time to cancer diagnosis and (b) cancer diagnostic activity for 22 cancer sites
  2. Estimate the early impact of the revision of National Institute for Health and Care Excellence (NICE) guidelines for suspected cancer in 2015 on the time to diagnosis of cancer
  3. Establish robust data on current times to diagnosis and diagnostic activity for these 22 cancers, creating benchmarks for future evaluation of change
  4. Explore the impact of the NICE suspected guidelines updates in 2011 and 2015 on resource use, tests and referrals made within GP practises and the costs associated with these

Diagnostic activity (including investigations and referrals for suspected cancer) increased progressively between 2005 and 2015, the year that the NICE guidance was revised. It is likely that the research evidence underpinning the new guidelines also influenced this increase in activity. To some extent, the 2015 NICE guidelines codified trends in clinical practice. With this in mind, we will explore methods that are subtle enough to detect any impact of the NICE guidelines.

We will use individual patient-level data from CPRD (Clinical Practice Research Datalink) to study how time to diagnosis and diagnostic test activity change over time. We will adjust for background trends in these outcomes and quantify how much change can be put down to the revision of the guidelines in 2015. This work will be complemented by a study exploring the impact of the NICE suspected cancer guidelines on GPs resource in the 11 cancer sites where the guidelines changed.

A further analysis will explore the extent of missed opportunities within GP practices to refer symptomatic patients with cancer. For this additional analysis we will focus on two main cancer sites that involve blood or stool tests within primary care: ovarian (CA125 blood test) and colorectal cancer (FOB or FITs test).

It is important to have robust procedures in place so that we can evaluate cancer diagnostic activity and times to diagnosis on a regular basis. This study will work out what resources are needed to do this, how we can do it efficiently and also lay down benchmarks for the future evaluation of change.

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