Abstract
Background
Time to diagnosis (TTD) concerns teenagers and young adults (TYA) with cancer and may affect outcome.
Methods
Healthcare records from 105 TYA in a regional cancer service were assessed to document events from 1st symptom to treatment start. Detailed pathway construction was possible for 104 patients and allowed a multidisciplinary panel review of each pathway with assessment of good practice and lessons for the future.
Results
1st presentation was to primary care in 86%, and 93% consulted in primary care before diagnosis. Routes to Diagnosis were 45% via urgent Two Week Wait pathways and 38% as emergency referrals. Total Interval (time from 1st presentation to treatment start) was median 63 (range 1-59) days, varying within/between diagnoses. Patient interval (time from 1st symptom to 1st presentation) was longest for lymphoma, carcinoma and bone tumour (medians: 9, 12, 20 days). Overall, time in primary care was short (median 3, range 0-537 days) compared to secondary care (median 29, range 0-195 days) and longest for lymphoma, carcinoma, brain/CNS (medians: 10, 15, 16 days). Specialist Care interval (time from 1st specialist visit to treatment start) was longest for bone, brain/CNS, lymphoma, carcinoma (medians: 30, 33, 36, 48 days). 40% pathways were rated as showing good/best practice but 16% were less than satisfactory. Continued safety-netting/support was identified from PC but there were opportunities for improvement in transition through secondary care.
Conclusions
Previous reports of prolonged TTD have focused on delay in referral from primary care but this study suggests that delay can be reduced by optimising management in secondary care.
Time to diagnosis (TTD) concerns teenagers and young adults (TYA) with cancer and may affect outcome.
Methods
Healthcare records from 105 TYA in a regional cancer service were assessed to document events from 1st symptom to treatment start. Detailed pathway construction was possible for 104 patients and allowed a multidisciplinary panel review of each pathway with assessment of good practice and lessons for the future.
Results
1st presentation was to primary care in 86%, and 93% consulted in primary care before diagnosis. Routes to Diagnosis were 45% via urgent Two Week Wait pathways and 38% as emergency referrals. Total Interval (time from 1st presentation to treatment start) was median 63 (range 1-59) days, varying within/between diagnoses. Patient interval (time from 1st symptom to 1st presentation) was longest for lymphoma, carcinoma and bone tumour (medians: 9, 12, 20 days). Overall, time in primary care was short (median 3, range 0-537 days) compared to secondary care (median 29, range 0-195 days) and longest for lymphoma, carcinoma, brain/CNS (medians: 10, 15, 16 days). Specialist Care interval (time from 1st specialist visit to treatment start) was longest for bone, brain/CNS, lymphoma, carcinoma (medians: 30, 33, 36, 48 days). 40% pathways were rated as showing good/best practice but 16% were less than satisfactory. Continued safety-netting/support was identified from PC but there were opportunities for improvement in transition through secondary care.
Conclusions
Previous reports of prolonged TTD have focused on delay in referral from primary care but this study suggests that delay can be reduced by optimising management in secondary care.
| Original language | English |
|---|---|
| Article number | 616 |
| Number of pages | 15 |
| Journal | BMC Cancer |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 24 Jun 2019 |
Keywords
- Primary care
- Routes to diagnosis
- Secondary care
- Time to diagnosis
- TYA
Access to Document
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This is the final published version of the article (version of record). It first appeared online via Springer Nature at https://doi.org/10.1186/s12885-019-5776-0 . Please refer to any applicable terms of use of the publisher.