Comparison between the 2018 and 2014 National Cancer Diagnosis Audits for England

Abstract

Background: Timely diagnosis of cancer in patients who present with symptoms in primary care is a quality improvement priority. Aim: To examine possible changes to aspects of the diagnostic process and its timeliness before and after publication of the 2015 NICE Guideline for the referral of suspected cancer in primary care. Design and setting: Population-based clinical audits of cancer diagnosis in general practices in England for patients diagnosed in 2018 or 2014. Method: GPs in 1878 (2018) and 439 (2014) practices collected information on cancer patients. Data included patient characteristics, place of presentation, number of consultations, use of primary care investigations, referral type and perceived avoidable diagnostic delays. Results: Among 64 489 (2018) and 17 042 (2014) records of a new cancer diagnosis, the percentage of patients with same-day referral (denoted by a primary care interval of 0 days) was higher in 2018 (43% vs. 38%) with similar changes in median diagnostic interval (36 days vs. 40 days). Compared to 2014, fewer patients had 3+ consultations before referral (19% vs. 26%). Use of primary care investigations increased (48% vs. 45%). Urgent cancer referrals increased (55% vs. 52%) while emergency referrals decreased (13% vs. 17%). Recorded use of safety netting was lower (40% vs. 44%). Conclusion: In a 5-year period including the year when national guidelines were updated, there were substantial improvements in the diagnostic process of patients who present to general practice in England with symptoms of a subsequently diagnosed cancer.