Two Week Wait Referrals: Conversion and Detection Rates

Data on conversion and detection rates for two week wait referrals is now available for up to 14 tumour types for the first time. This data provides an insight into referral activities and their contribution to diagnostic pathways.

  • Urgent suspected cancer referrals (commonly known as, two-week wait referrals) are used to refer patients with possible cancer symptoms to secondary care for investigation and possible diagnosis.
  • Conversion rate is the percentage of urgent suspected cancer referrals which result in a diagnosis of cancer.
  • Detection rate is the percentage of cases recorded in the Cancer Waiting Times data as receiving a first treatment for cancer which resulted from an urgent suspected cancer referral.

Output available for 2009/10 to 2018/19

Urgent Suspected Cancer Referrals Conversion and Detection 2009-2019 workbook: This workbook presents data for England by financial years, running from 1st April to 31st March, from April 2009 onwards. The years included are based on: 

  • Conversion rates: The date first seen in secondary care for urgent suspected cancer referrals.
  • Detection rates: The treatment start date for patients receiving a first treatment for cancer.

The percentage of urgent suspected cancer referrals which result in cancer diagnosis has decreased from 10.8% for 2009/10 to 7.1% for 2018/19 in England. A decrease in conversion rates indicates that Trusts are seeing more TWW patients who do not have cancer. It is important to understand where this is happening ( geographical area and tumour type ) for service planning.

In the same period, the percentage of cases receiving treatment for cancer which resulted from an urgent suspected cancer referral increased from 42.3% to 53.1%. An increase in detection rates indicates that Trusts are detecting a higher proportion of new cancers from urgent suspected cancer referrals.

Notes

Dataset: Cancer Waiting Times (CWT) data, is provided by NHS England and NHS Improvement, and NHS Digital. This dataset is used to support the management and monitoring of cancer services in England, recording details of all urgent suspected cancer referrals and all patients receiving a first treatment for cancer.

Referral types for conversion rates:

Conversion rate data is available for 14 broad referral types based on the CWT two week wait cancer or symptomatic breast referral types, as follows:

TWW_ref_codes

Cancer sites for detection rates:

Detection rate data is available for 12 broad cancer sites which relate to the urgent suspected cancer referral types. These site groups are based on the primary diagnosis code recorded in the CWT data for the first treatment record, which is classified using the 10th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), a medical classification list produced by the World Health Organisation (WHO). ICD-10 codes have been grouped into sites related to the urgent suspected cancer referral types, as follows:

TWW_Site_codes

All-cancer data compared to site-specific data:

  • All-cancer data: Conversion rates and detection rates are based on any referral type (except breast symptom referrals) and any cancer site, including diagnoses of a cancer type different to the suspected cancer referral type (e.g. including diagnoses of lower GI cancer following an urgent referral for suspected upper GI cancer).
  • Site-specific data: Conversion rates and detection rates are based on referrals and diagnoses of the same referral type and cancer site (e.g. the urological cancer detection rate is the percentage of urological cancers which resulted from an urgent referral for suspected urological cancers). Exceptions to this are:

         - conversion rates for suspected children’s cancer, suspected sarcoma and other suspected cancer which

           include all diagnoses;

         - cancer diagnoses for children which are included in detection rates for all individual cancer sites rather than

           as separate detection rate, and; 

         - detection rates for sarcoma and other cancers which include urgent referrals for any suspected cancer.

Unavailable data:

As detection rate is based on the ICD-10 diagnosis code, the data is not available separately for:

  • Children: Instead, all diagnoses for children (including those which resulted from an urgent suspected children’s cancer referral) are included under the relevant cancer site of diagnosis.
  • Breast symptoms: Instead, breast cancer diagnoses which resulted from a breast symptoms referral are included within the breast cancer detection rate.

Other data sources:

  • Cancer Services: All-cancer conversion rates and detection rates are available for GP practices, primary care networks and CCGs, based on registered GP practice.
  • Cancer waiting times statistics: Levels of activity and performance for cancer waiting times are available for providers and commissioners.

Acknowledgements:

This work has been produced in collaboration, involving analysts from: the National Cancer Registration and Analysis Service, Public Health England (PHE); the Cancer Research UK – PHE partnership; the Transforming Cancer Services Team – PHE partnership; and the Cancer Alliances Data, Evidence and Analysis Service, NHS England and NHS Improvement – PHE partnership.

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. It is sourced from NHS Digital, and NHS England and NHS Improvement and collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England.