Variation in suspected cancer referral pathways across the International Cancer Benchmarking Partnership: a comparative analysis

Abstract

Background: International variation in cancer outcomes persist. Differences in the accessibility and organisation of cancer patient pathways may influence this. More evidence is needed to understand what extent variations in the structure of primary care referral pathways for cancer investigation contribute to differences in timeliness of diagnoses and cancer outcomes. Aim: To explore the variation in primary care referral pathways for the management of suspected cancer across the International Cancer Benchmarking Partnership countries. Design: Descriptive comparative analysis; mixed methods. Methods: Schematics of primary care referral pathways were developed across 10 ICBP jurisdictions. The Aarhus statement initially informed the development of the schematics, further supplemented with expert insights through consultation of leading experts in primary care and cancer, existing ICBP, focussed review of existing evidence on the management of suspected cancer, published primary care cancer guidelines, and evaluations of referral tools and initiatives within primary care. Results: Referral pathway schematics for 10 ICBP jurisdictions are presented alongside a descriptive comparison of the organisation of primary care management of suspected cancer. Several key areas of variation were identified: inflexibility of referral pathways, lack of a managed route for non-specific symptoms, primary care practitioner decision-making autonomy, direct access to investigations and use of emergency routes. Conclusion: Highlighting differences in referral processes can stimulate further research to better understand the impact of this variation on timeliness of diagnoses and cancer outcomes. Studying these schematics in local contexts may identify opportunities to improve care and facilitate discussions of what may constitute best referral practice.