Introduction The UK has significantly poorer cancer survival rates than comparable countries and diagnostic delay is perceived to be a significant contributory factor to this. The RCGP National Audit of Cancer Diagnosis in Primary Care (2009/10) included data on 3655 patients with colorectal and gastro-oesophageal cancer, including free text comments on avoidable delays in diagnosis, as perceived by the participating GPs. The aim of this study was to identify the principal causes of delay, as perceived by GPs, and how they differ by cancer site.
Methods Avoidable delay was reported for 36% of patients with colorectal cancer, 37% gastric cancer and 35% oesophageal cancer. Free text reports of the nature of the delay were available for 753 (28%) colorectal, 87 (28%) gastric and 164 (27%) oesophageal cancer patients. An extended version of The Model of Pathways to Treatment (Walter et al 2011) was developed for use as the analytical framework. Comments were categorised by CD with uncertain cases discussed and resolved with GR. In order to validate GP perceptions of diagnostic delay we compared categorised primary care and referral intervals for patients with and without perceived delay.
Results Primary care and referral intervals were significantly longer for patients with a perceived avoidable diagnostic delay (p = <0.0001), for all three cancer sites. The commonest reasons for delay for colorectal, gastric and oesophageal cancer patients were GP appraisal (29%, 14%, 16% respectively), referral delays (e.g. routine rather than 2 week wait) (13%, 23%, 32% respectively) and investigation delays (28%, 34%, 27% respectively). For colorectal cancer patients, help seeking delay was also a significant cause of delay (8%). Because causes of delay were reported by GPs there was a potential reporting bias, with delays occurring prior to first consultation or in secondary care possibly being under-reported.
Conclusion Diagnostic delay for patients with upper and lower GI cancers is multi-faceted, with GP appraisal and type of referral perceived as substantial contributors. Interventions aimed at reducing the time to diagnosis should be targeted at the key causes and settings of delay for different cancer sites.
Disclosure of Interest None Declared
Walter, F. Webster, A., Scott, S. & Emery, J. (2012) ‘The Andersen Model of total patient delay: A systematic review of its application in cancer diagnosis.’ Journal of Health Services Research and Policy Vol.17, No.2, pp.110–118.
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