Cancer detection via primary care urgent referral and association with practice characteristics: a retrospective cross-sectional study in England from 2009/2010 to 2018/2019
Open Access
- 25 June 2021
- journal article
- research article
- Published by Royal College of General Practitioners in British Journal of General Practice
- Vol. 71 (712), e826-e835
- https://doi.org/10.3399/bjgp.2020.1030
Abstract
Background There is substantial variation in the use of urgent suspected cancer referral (2-week wait [2WW]) between practices. Aim To examine the change in use of 2WW referrals in England over 10 years (2009/2010 to 2018/2019) and the practice and population factors associated with cancer detection. Design and setting Retrospective cross-sectional study of English general practices and their 2WW referral and Cancer Waiting Times database detection data (all cancers other than non-melanoma skin cancers) from 2009/2010 to 2018/2019. Method A retrospective study conducted using descriptive statistics of changes over 10 years in 2WW referral data. Yearly linear regression models were used to determine the association between cancer detection rates and quintiles of practice and population characteristics. Predicted cancer detection rates were calculated, as well as the difference between lowest to highest quintiles. Results Over the 10 years studied there were 14.89 million 2WW referrals (2.24 million in 2018/2019), and 2.68 million new cancer diagnoses, of which 1.26 million were detected following 2WW. The detection rate increased from 41% to 52% over the time period. In 2018/2019 an additional 66 172 cancers were detected via 2WW compared with 2009/2010. Higher cancer detection via 2WW referrals was associated with larger practices and those with younger GPs. From 2016/2017 onwards more deprived practice populations were associated with decreased cancer detection. Conclusion From 2009/2010 to 2018/2019 2WW referrals increased on average by 10% year on year. The most consistent association with higher cancer detection was found for larger practices and those with younger GPs, though these differences became attenuated over time. The more recent association between increased practice deprivation and lower cancer detection is a cause for concern. The COVID-19 pandemic has led to significant impacts on 2WW referral activity and the impact on patient outcomes will need to be studied.This publication has 51 references indexed in Scilit:
- Secondary care intervals before and after the introduction of urgent referral guidelines for suspected cancer in Denmark: a comparative before-after studyBMC Health Services Research, 2013
- Variation in gastroscopy rate in English general practice and outcome for oesophagogastric cancer: retrospective analysis of Hospital Episode StatisticsGut, 2013
- General practitioner characteristics and delay in cancer diagnosis. a population-based cohort studyBMC Family Practice, 2011
- Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic studyBritish Journal of General Practice, 2011
- Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry dataThe Lancet, 2011
- Identifying Poorly Performing General Practices in England: A Longitudinal Study Using Data from the Quality and Outcomes FrameworkJournal of Health Services Research & Policy, 2011
- Explaining variation in referral from primary to secondary care: cohort studyBMJ, 2010
- Delay in diagnosis: the experience in DenmarkBritish Journal of Cancer, 2009
- Primary Care Physician Specialty Referral Decision Making: Patient, Physician, and Health Care System DeterminantsMedical Decision Making, 2006
- THE INVERSE CARE LAWThe Lancet, 1971