Comparing diagnostic delay in cancer: a cross-sectional study in three European countries with primary care-led health care systems.

BACKGROUND: The principal aim of this study was to determine the feasibility of a large-scale comparative study, between the UK, the Netherlands and Sweden, to investigate whether delays in the diagnostic pathway of cancer might explain differences in cancer survival between countries. METHODS: Following a planning meeting to agree the format of a data collection instrument, data on delays in the cancer diagnostic pathway were abstracted from primary care-held medical records. Data were collected on 50 cases each (total of 150) from practices in each of Grampian, Northeast Scotland; Maastricht, the Netherlands and Skane, Sweden. Data were entered into SPSS 18.0 for analysis. RESULTS: Data on delays in the cancer diagnostic pathway were readily available from primary care-held case records. However, data on demographic variables, cancer stage at diagnosis and treatment were less well recorded. There was no significant difference between countries in the way in which cases were referred from primary to secondary care. There was no significant difference between countries in the time delay between a patient presenting in primary care and being referred to secondary care. Median delay between referral and first appointment in secondary care [19 (8.0-47.5) days] was significantly longer in Scotland that in Sweden [1.0 (0-31.5) days] and the Netherlands [5.5 (0-31.5) days] (P < 0.001). Secondary care delay (between first appointment in secondary care and diagnosis) in Scotland [22.5 (0-39.5) days] was also significantly longer than in Sweden [14.0 (4.5-31.5) days] and the Netherlands [3.5 (0-16.5) days] (P = 0.003). Finally, overall delay in Scotland [53.5 (30.3-96.3) days] was also significantly longer than in Sweden [32.0 (14.0-71.0) days] and the Netherlands [22.0 (7.0-60.3) days] (P = 0.003). CONCLUSIONS: A large-scale study comparing cancer delays in European countries and based on primary care-held records is feasible but would require supplementary sources of data in order to maximize information on demographic variables, the cancer stage at diagnosis and treatment details. Such a large-scale study is timely and desirable since our findings suggest systematic differences in the way cancer is managed in the three countries.

European differences in cancer survival: report of an international symposium of general practitioners from three countries exploring primary and secondary care delay.

BACKGROUND: There are several potential delays in the cancer diagnostic pathway: patient delay, primary care delay and secondary care delay. People in the UK have poorer five-year survival from many cancers compared with people in European countries with similar healthcare systems. The reasons for this are not clear, although it has been postulated that UK patients may present with cancer at a later stage. We are conducting a study to investigate the feasibility of comparing diagnostic delays in different European countries. METHODS: (conduct of the symposium): A half-day, round-table symposium was convened with seven general practitioners (GPs) and single primary care researchers from Sweden (Malmö), the Netherlands (Maastricht) and Scotland (Aberdeen). In Session One the group had a broad-ranging discussion comparing and contrasting their different working contexts and how these might impact on the cancer diagnostic pathway. In Session Two the group considered two case studies from Scotland, applying their own local experience and the insights generated in Session One to identify common and divergent issues. When it had finished the facilitator drafted a detailed report of the symposium which was supported by reference to the individual participants' notes which had been collected at the end of the symposium. RESULTS: (consensus views reached): Sweden, the Netherlands and Scotland have strong traditions of primary care acting in a gate-keeping role. People with cancer in the three countries following a broadly similar cancer diagnostic pathway. In Sweden and the Netherlands GPs have direct unscreened access to a greater range of investigations than in Scotland. In Scotland there is a greater reliance on specialist guidelines than in the Netherlands or Sweden. Future research in the UK could explore the potential contribution of increased GP access to investigations and revised referral guidelines.