Variation in timeliness of diagnostic investigations for symptomatic patients and effect on cancer outcomes: facilitating the implementation of Faster Diagnosis Standards

Start Date Jul 2021

Code U9-Aff

Status Ongoing

Project Lead
Dr Monica Koo, Dr Meena Rafiq (both UCL), Prof Niek de Wit, Dr Charles Helsper (Utrecht)


Diagnosing cancer at an early stage and before it becomes a medical emergency is paramount for improving survival, patient experience and disruptions to health services. Efforts to improve the timely diagnosis of cancer for symptomatic patients comprise fast-track diagnostic pathways, cancer waiting time targets, including the recent Faster Diagnosis Standards (FDS), rapid access diagnostic centres for patients with non-specific symptoms and the increased use of primary care tests, such as faecal immunochemical testing (FIT), for triaging symptomatic patients needing invasive hospital-based investigations. While improvements have been achieved, large proportions of cancer patients are still diagnosed following an emergency admission and/or with late stage disease.

The COVID-19 pandemic, during which two week-wait referrals have fallen by 80% and many investigations have been postponed, highlights the urgent need of identifying patient groups at higher risk of delays and adverse outcomes.

External Funding

The project has been successfully peer reviewed and approved for funding by Cancer Research UK’s Early Detection & Diagnosis Committee. Reference number A31452. Award £118,000

Aims & objectives

To help improve diagnostic pathways, we aim to characterise patient groups at risk of prolonged diagnostic intervals, identifying where delays occur and the impact on cancer outcomes.

We aim to answer the following questions:


The study will include patients aged 18 and older with signs/symptoms potentially related to gastro-intestinal or lung cancer recorded in primary care during 2011-2020, using the Clinical Practice Research Datalink (CPRD). The data will be linked to the National Cancer Registry (NCRAS), Hospital Episode Statistics (HES) (including outpatient/admitted patient care), diagnostic imaging data (DID) and Cancer Waiting Times (CWT).

Outputs & impact

Future impact and benefits:

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