Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets

TLDR

Cancer survival in England lags the European average, partly because patients are diagnosed at later stages, with notable regional and demographic disparities and most cases presenting symptomatically or incidentally. This study defines a methodology to categorize the patient journey to diagnosis, enabling examination of demographic, organisational, service, and personal factors contributing to diagnostic delay. The authors linked Hospital Episode Statistics, Cancer Waiting Times, screening programme data, and cancer registration records for all 2006–2008 cases in England and classified each into one of eight “Routes to Diagnosis.” The eight routes revealed substantial cancer‑type differences, with emergency presentations associated with markedly lower 1‑year relative survival, demonstrating that linked administrative data can reliably classify diagnosis routes and aid investigation of diagnostic delays.

Abstract

Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The majority of patients are diagnosed following symptomatic or incidental presentation. This study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis. Administrative Hospital Episode Statistics data are linked with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. Using these data sets, every case of cancer registered in England, which was diagnosed in 2006–2008, is categorised into one of eight 'Routes to Diagnosis'. Different cancer types show substantial differences between the proportion of cases that present by each route, in reasonable agreement with previous clinical studies. Patients presenting via Emergency routes have substantially lower 1-year relative survival. Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis.