Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: Evidence from 670 000 patients with cancers of 35 different sites
dc.contributor.author | Zhou, Y | |
dc.contributor.author | Mendonca, SC | |
dc.contributor.author | Abel, GA | |
dc.contributor.author | Hamilton, W | |
dc.contributor.author | Walter, FM | |
dc.contributor.author | Johnson, S | |
dc.contributor.author | Shelton, J | |
dc.contributor.author | Elliss-Brookes, L | |
dc.contributor.author | McPhail, S | |
dc.contributor.author | Lyratzopoulos, G | |
dc.date.accessioned | 2019-02-07T16:04:02Z | |
dc.date.issued | 2017-11-28 | |
dc.description.abstract | Background:In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups.Methods:We examined data from 669 220 patients with 35 cancers diagnosed in 2006-2010 following either fast-track or 'routine' primary-to-secondary care referrals using 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer.Results:There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer.Conclusions:Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for 'alarm' symptoms are needed to improve diagnostic timeliness. | en_GB |
dc.description.sponsorship | Cancer Research UK | en_GB |
dc.description.sponsorship | Wellcome Trust | en_GB |
dc.identifier.citation | Vol. 118, pp. 24 - 31 | en_GB |
dc.identifier.doi | 10.1038/bjc.2017.381 | |
dc.identifier.grantnumber | C18081/A18180 | en_GB |
dc.identifier.grantnumber | Primary Care Clinician Doctoral Fellow | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/35820 | |
dc.language.iso | en | en_GB |
dc.publisher | Springer Nature | en_GB |
dc.rights | © The Author(s) 2018. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/ 4.0/ | en_GB |
dc.subject | cancer diagnosis | en_GB |
dc.subject | diagnostic pathway | en_GB |
dc.subject | cancer epidemiology | en_GB |
dc.subject | primary care | en_GB |
dc.subject | early diagnosis | en_GB |
dc.title | Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: Evidence from 670 000 patients with cancers of 35 different sites | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2019-02-07T16:04:02Z | |
dc.identifier.issn | 0007-0920 | |
dc.description | This is the final published version. Available from Springer Nature via the DOI in this record. | en_GB |
dc.identifier.journal | British Journal of Cancer | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2017-09-26 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2017-09-26 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2019-02-07T16:00:16Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2019-02-07T16:04:05Z | |
refterms.panel | A | en_GB |
refterms.depositException | publishedGoldOA |
Files in this item
This item appears in the following Collection(s)
Except where otherwise noted, this item's licence is described as © The Author(s) 2018. This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits
use, sharing, adaptation, distribution and reproduction in any
medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative
Commons license, and indicate if changes were made. The images
or other third party material in this article are included in the
article’s Creative Commons license, unless indicated otherwise in a
credit line to the material. If material is not included in the article’s
Creative Commons license and your intended use is not permitted
by statutory regulation or exceeds the permitted use, you will need
to obtain permission directly from the copyright holder. To view a
copy of this license, visit http://creativecommons.org/licenses/by/
4.0/