Explaining variation in cancer outcomes between eleven jurisdictions in the International Cancer Benchmarking Partnership: a primary care survey

Background The International Cancer Benchmarking Partnership (ICBP), is a collaboration between six countries and 12 jurisdictions with similar primary care led health services. This study investigates factors that may contribute to survival differences across these jurisdictions. Methods A validated survey was sent to primary care physicians (PCPs) in the 12 jurisdictions. The survey had two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer. Results 2795 PCPs responded. Four of five vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographic, practice and health system variables. Interpretation We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer – either directly, or by specialist referral to improve outcomes.