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Primary care characteristics and stage of cancer at diagnosis using data from the national cancer registration service, quality outcomes framework and general practice information.

Maclean R, Jeffreys M, Ives A, Jones T, Verne J, Ben-Shlomo Y - BMC Cancer (2015)

Bottom Line: A higher rate of gastrointestinal investigations was associated with a lower proportion of later stage colorectal cancers (RD -2.0% (95 % CI -0.6% to -3.6%) p = 0.01).No organisational characteristics were associated with prostate cancer stage.Easier access to primary care, faster referral and more investigation for gastrointestinal symptoms could reduce the proportion of people diagnosed later for female breast, lung and colorectal, but not prostate cancer.

View Article: PubMed Central - PubMed

Affiliation: Speciality Registrar in Public Health, NHS England, South Plaza, Marlborough Street, Bristol, BS1 3NX, UK. Rebecca.maclean1@nhs.net.

ABSTRACT

Background: Survival from cancer is worse in England than in some European countries. To improve survival, strategies in England have focused on early presentation (reducing delay to improve stage at diagnosis), improving quality of care and ensuring equity throughout the patient pathway. We assessed whether primary care characteristics were associated with later stage cancer at diagnosis (stages 3/4 versus 1/2) for female breast, lung, colorectal and prostate cancer.

Methods: Data obtained from the National Cancer Registration Service, Quality Outcomes Framework, GP survey and GP workforce census, linked by practice code. Risk differences (RD) were calculated by primary care characteristics using a generalised linear model, accounting for patient clustering within practices. Models were adjusted for age, sex and an area-based deprivation measure.

Results: For female breast cancer, being with a practice with a higher two week wait (TWW) referral rate (RD -1.8% (95 % CI -0.5% to -3.2%) p = 0.003) and a higher TWW detection rate (RD -1.7% (95 % CI -0.3% to -3.0%) p = 0.003) was associated with a lower proportion diagnosed later. Being at a practice where people thought it less easy to book at appointment was associated with a higher percentage diagnosed later (RD 1.8% (95 % CI 0.2% to 3.4%) p = 0.03). For lung cancer, being at practices with higher TWW referral rates was associated with lower proportion advanced (RD-3.6% (95 % CI -1.8%, -5.5%) p < 0.001) whereas being at practices with more patients per GP was associated with higher proportion advanced (RD1.8% (95 % CI 0.2, 3.4) p = 0.01). A higher rate of gastrointestinal investigations was associated with a lower proportion of later stage colorectal cancers (RD -2.0% (95 % CI -0.6% to -3.6%) p = 0.01). No organisational characteristics were associated with prostate cancer stage.

Conclusion: Easier access to primary care, faster referral and more investigation for gastrointestinal symptoms could reduce the proportion of people diagnosed later for female breast, lung and colorectal, but not prostate cancer. Differences between the four main cancers suggest different policies may be required for individual cancers to improve outcomes.

No MeSH data available.


Related in: MedlinePlus

Data flow due to data linkage, missing data and exclusions from dataset
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4491217&req=5

Fig1: Data flow due to data linkage, missing data and exclusions from dataset

Mentions: We were able to link across a numner of different datasets by using the unique GP code [10], where available and valid thereby providing us information on cancer characteristics, general practice level features and patient perceptions about their practice. This process and losses of data for a variety of different reasons including exclusions is shown in a flow diagram (Fig. 1)Fig. 1


Primary care characteristics and stage of cancer at diagnosis using data from the national cancer registration service, quality outcomes framework and general practice information.

Maclean R, Jeffreys M, Ives A, Jones T, Verne J, Ben-Shlomo Y - BMC Cancer (2015)

Data flow due to data linkage, missing data and exclusions from dataset
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491217&req=5

Fig1: Data flow due to data linkage, missing data and exclusions from dataset
Mentions: We were able to link across a numner of different datasets by using the unique GP code [10], where available and valid thereby providing us information on cancer characteristics, general practice level features and patient perceptions about their practice. This process and losses of data for a variety of different reasons including exclusions is shown in a flow diagram (Fig. 1)Fig. 1

Bottom Line: A higher rate of gastrointestinal investigations was associated with a lower proportion of later stage colorectal cancers (RD -2.0% (95 % CI -0.6% to -3.6%) p = 0.01).No organisational characteristics were associated with prostate cancer stage.Easier access to primary care, faster referral and more investigation for gastrointestinal symptoms could reduce the proportion of people diagnosed later for female breast, lung and colorectal, but not prostate cancer.

View Article: PubMed Central - PubMed

Affiliation: Speciality Registrar in Public Health, NHS England, South Plaza, Marlborough Street, Bristol, BS1 3NX, UK. Rebecca.maclean1@nhs.net.

ABSTRACT

Background: Survival from cancer is worse in England than in some European countries. To improve survival, strategies in England have focused on early presentation (reducing delay to improve stage at diagnosis), improving quality of care and ensuring equity throughout the patient pathway. We assessed whether primary care characteristics were associated with later stage cancer at diagnosis (stages 3/4 versus 1/2) for female breast, lung, colorectal and prostate cancer.

Methods: Data obtained from the National Cancer Registration Service, Quality Outcomes Framework, GP survey and GP workforce census, linked by practice code. Risk differences (RD) were calculated by primary care characteristics using a generalised linear model, accounting for patient clustering within practices. Models were adjusted for age, sex and an area-based deprivation measure.

Results: For female breast cancer, being with a practice with a higher two week wait (TWW) referral rate (RD -1.8% (95 % CI -0.5% to -3.2%) p = 0.003) and a higher TWW detection rate (RD -1.7% (95 % CI -0.3% to -3.0%) p = 0.003) was associated with a lower proportion diagnosed later. Being at a practice where people thought it less easy to book at appointment was associated with a higher percentage diagnosed later (RD 1.8% (95 % CI 0.2% to 3.4%) p = 0.03). For lung cancer, being at practices with higher TWW referral rates was associated with lower proportion advanced (RD-3.6% (95 % CI -1.8%, -5.5%) p < 0.001) whereas being at practices with more patients per GP was associated with higher proportion advanced (RD1.8% (95 % CI 0.2, 3.4) p = 0.01). A higher rate of gastrointestinal investigations was associated with a lower proportion of later stage colorectal cancers (RD -2.0% (95 % CI -0.6% to -3.6%) p = 0.01). No organisational characteristics were associated with prostate cancer stage.

Conclusion: Easier access to primary care, faster referral and more investigation for gastrointestinal symptoms could reduce the proportion of people diagnosed later for female breast, lung and colorectal, but not prostate cancer. Differences between the four main cancers suggest different policies may be required for individual cancers to improve outcomes.

No MeSH data available.


Related in: MedlinePlus