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

Introduction

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:

• For patients with given symptoms, does the use of specific hospital investigations and their timeliness differ by patient clinical and socio-demographic characteristics?
• What are the effects of different types of investigations and their timing on stage at diagnosis, emergency presentations and short-term survival?
• What are the mechanisms linking clinical characteristics to diagnostic timeliness and cancer outcomes?

Methodology

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:

• The research will characterise patient groups at higher risk of prolonged diagnostic intervals and not meeting the FDS and help target improvement efforts to reduce emergency and advanced stage cancer diagnosis.
• The findings will inform guidelines and healthcare policies on referrals/access to investigations and identify priority areas where specific diagnostic capacity is needed (for example, for patients with specific morbidities/multimorbidity presenting with certain symptoms).
• The analyses will improve our understanding of underlying mechanisms and provide estimates on the benefits of specific hospital-based investigations for well-defined patient groups.