Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey.
ICBP Module 3 Working Group*
ICBP Module 3 Working Group
BMJ Publishing Group
This is the final version of the article. Available from BMJ Publishing Group via the DOI in this record.
OBJECTIVES: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences. DESIGN: A validated survey administered to PCPs via the internet set out in 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. PARTICIPANTS: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden. PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate. RESULTS: 4 of 5 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 demographics, practice or health system variables. CONCLUSIONS: 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.
This work was supported by Canadian Partnership Against Cancer; Cancer Care Manitoba; Cancer Care Ontario; Cancer Council Victoria; Cancer Institute New South Wales; Danish Health and Medicines Authority; Danish Cancer Society; Department of Health, England; Department of Health, Victoria; Northern Ireland Cancer Registry; The Public Health Agency, Northern Ireland; Norwegian Directorate of Health; South Wales Cancer Network; Swedish Association for Local Authorities and Regions; Tenovus; British Columbia Cancer Agency; and the Welsh Government.
Research Support, Non-U.S. Gov't
Vol. 5, Iss. 5, pp. e007212 -
Place of publication