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Improving Cancer Diagnosis: Insights from the Primary Care Audit

The audit highlights that late cancer diagnosis significantly impacts survival rates in the UK compared to Europe. Initiated by the RCGP and Durham University, this national audit analyzes referrals to identify delays in cancer diagnosis. Examining data from September 2008 to March 2009, the audit encompasses over 500 cases across various cancer types. Key insights reveal avoidable delays in diagnosis stemming from patient factors, referral processes, and healthcare system inefficiencies. The findings aim to enhance practices and develop educational resources for primary care teams.

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Improving Cancer Diagnosis: Insights from the Primary Care Audit

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  1. MVCN Primary Care Audit -Background • Evidence suggests that later diagnosis of cancer has been a major factor in the poorer survival rates in the UK compared with some other countries in Europe. • CRS recommendation to look in detail at referrals of cancer cases to help identify delays & learning points. • RCGP & Durham university developed national audit template and are collating national results. • Retrospective case analysis of all new cancers diagnosed between Sept 2008 & March 2009, excluding screening detected cases and non-melanoma skin cancers. • LES established in Herts PCT to fund practices to take part.

  2. comparisons • Where available I have compared with figures presented by the following networks • Greater Midlands cancer network • Anglia cancer network (interim results)

  3. Results (1) • 31 of 141 practices (22%) took part(42.8%)(40%) • 521 cases (1530) (2381) • Average age 68 years (67)(46% (47%) women) • >90% white british (85%) • 7% housebound (6%) • 16.5% died within 18 months of diagnosis

  4. Results (2) • Cancer types • Prostate 17.3% (17%) (17%) • Breast 16.5% (16%) (14.5%)(n.b screening cases excluded) • Colorectal 13.2% (15%) (13.8%) • Lung 9.6% (9%) (8%) • Bladder 4.8% (4%) (6%) • Lymphoma 4.4% (4%) (4%) • Melanoma 3.8% (4%) (7%) • Oesophageal 3.6% (4%) (2.5%)

  5. Results(3) Cancer stage

  6. Stage at diagnosis for the four most prevalent tumour sites MVCN

  7. Stage at diagnosis for the four most prevalent tumour sites Greater Midlands CN

  8. Results (4) Referral type & delays

  9. Avoidable delays • Comments have been collated & grouped • Patient factors (11%)– delay to present/choice/DNA/other health problems • Referral route/process (18%) (e.g. not 2ww when should have been) • Diagnostic difficulties, complex presentation (23%) • Test factors (12%)– misleading or ‘normal’ test results • Primary Care Doctor delay (13%) – missed diagnosis • Secondary Care delay (22%)– cross-specialty referrals, test delays, lost notes

  10. Next steps • Detailed report prepared for sharing with national project, participating practices and board • To develop an education package for wide dissemination to practice teams to share learning points. Learning events, website. • Considering repeat audit. Targeted on specific tumour types.

  11. Summary • Feedback from participating practices – positive, valuable learning process • Comparable in most areas to Greater Midlands & Anglia networks results • Less 2ww referrals, more private & routine • Longer pathways in Lung, Colorectal & prostate • Avoidable delays in approx. 20%. Learning points identified for dissemination • GPs feel that access to diagnostics is a significant factor in only 6.5% (8%)(4%) of cases

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