Official Statistics

Diagnostic intervals for cancer, analysis by Route to Diagnosis in England, 2014 to 2015

Published 21 April 2020

1. Main points

An online interactive tool has been published containing analysis of variation in the Secondary Care Diagnostic Interval (SCDI) by 3 common routes to diagnosis and overall. The tool compares SCDI for 24 cancers diagnosed in England in 2014 to 2015. The time it takes cancer to be diagnosed is dependent on many factors and interval variation within each cancer site needs to be understood to find out what is driving longer diagnostic intervals.

2. Things you need to know

The SCDI is defined as the time from first relevant interaction in secondary care to diagnosis and was calculated for nearly 490,000 cancers in over 20 cancer sites for those diagnosed in 2014 and 2015. This was the first time a population-level interval of this kind had been calculated for multiple cancer sites.

Analysis undertaken in 2019 found significant variation by route to diagnosis, with emergency presentations having shortest median intervals and GP referrals having the longest. This pattern was evident across all cancers examined.

This new study explored this variation further, investigating variation within route of SCDIs of those diagnosed via:

• Two Week Wait (TWW, n = 195,251) where patients were diagnosed following an urgent GP referral for suspected cancer
• GP referrals (GP, n = 120,576) where patients were diagnosed following a routine GP referral (that is non TWW)
• emergency presentations (EP, n = 91,231) where the patient had an emergency attendance or emergency referral before diagnosis

An online tool displays SCDI variation in each of the 24 cancer sites by all routes combined and additionally by patient factors (age, sex, ethnic group), disease factors (stage, comorbidities), Cancer Alliance and for each of the 3 routes (TWW, GP and EP). There is significant variation and many complex patterns in different cancers, by route and other factors. Data can also be downloaded from this tool.

This tool provides important insights in the variation of time to diagnosis, which is useful for clinicians, policy makers and those interested in the earlier diagnosis of cancer. Understanding time to diagnosis for cancer patients is vital to improve the service and ensure patients receive timely diagnosis and treatment.

3. New insights by ethnicity, stage and comorbidity

In the TWW route, non-white people had longer SCDIs than white people in myeloma and uterus cancer; black people had longer SCDIs than white people in colorectal, lung, oesophagus and prostate cancers; Asian people had longer SCDIs than white people in lung and prostate cancers.

In the TWW route, there were no significant differences between stage and SCDI in most sites (exceptions: kidney, lung, ovary and prostate cancers). These unexpected findings for TWW are different from other routes and were masked in the original analysis which showed that later-stage diagnoses generally had shorter SCDIs.

In most route and site combinations, patients with other health conditions (comorbidities) generally had longer SCDIs, with the exception of cervical cancer and melanomas where SCDIs were similar for all comorbidity scores.

4. Links to related statistics

More details about the work can be found on the National Cancer Registration and Analysis Service page, including links to a blog, a published article and the original online interactive tool.

5. Methodology

We have detailed the methods, diagnostic codes used and other code for the project in a Standardised Operating Procedure. The results described above are all unadjusted, descriptive statistics.

6. Authors

Clare Pearson, Lorna Wills (CRUK-PHE partnership)

7. Acknowledgements

This work was undertaken as part of the CRUK-PHE partnership.

Data for this work is based on patient-level information collected by the NHS, as part of the care and support of cancer patients. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, PHE.