PT  - JOURNAL ARTICLE
AU  - Thomas Round
AU  - Carolynn Gildea
AU  - Mark Ashworth
AU  - Henrik Møller
TI  - Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study
AID  - 10.3399/bjgp20X709433
DP  - 2020 Jun 01
TA  - British Journal of General Practice
PG  - e389--e398
VI  - 70
IP  - 695
4099  - http://bjgp.org/content/70/695/e389.short
4100  - http://bjgp.org/content/70/695/e389.full
SO  - Br J Gen Pract2020 Jun 01; 70
AB  - Background There is considerable variation between GP practices in England in their use of urgent referral pathways for suspected cancer.Aim To determine the association between practice use of urgent referral and cancer stage at diagnosis and cancer patient mortality, for all cancers and the most common types of cancer (colorectal, lung, breast, and prostate).Design and setting National cohort study of 1.4 million patients diagnosed with cancer in England between 2011 and 2015.Method The cohort was stratified according to quintiles of urgent referral metrics. Cox proportional hazards regression was used to quantify risk of death, and logistic regression to calculate odds of late-stage (III/IV) versus early-stage (I/II) cancers in relation to referral quintiles and cancer type.Results Cancer patients from the highest referring practices had a lower hazard of death (hazard ratio [HR] = 0.96; 95% confidence interval [CI] = 0.95 to 0.97), with similar patterns for individual cancers: colorectal (HR = 0.95; CI = 0.93 to 0.97); lung (HR = 0.95; CI = 0.94 to 0.97); breast (HR = 0.96; CI = 0.93 to 0.99); and prostate (HR = 0.88; CI = 0.85 to 0.91). Similarly, for cancer patients from these practices, there were lower odds of late-stage diagnosis for individual cancer types, except for colorectal cancer.Conclusion Higher practice use of referrals for suspected cancer is associated with lower mortality for the four most common types of cancer. A significant proportion of the observed mortality reduction is likely due to earlier stage at diagnosis, except for colorectal cancer. This adds to evidence supporting the lowering of referral thresholds and consequent increased use of urgent referral for suspected cancer.