Routes to Diagnosis

qic_rtd_2016

Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The award-winning Routes to Diagnosis study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised, in order to examine demographic, organisational, service and personal reasons for delayed diagnosis. Initial Routes to Diagnosis results for patients diagnosed in 2007 were presented in a data briefing published in November 2010. Since then the methodology has been reviewed and the results have been updated to include patients diagnosed from 2006 to 2013. The latest results follow the same methodology as the 2006-2008 study. A case study was published in 2016 for the Quality in Care Programme.

Administrative Hospital Episode Statistics (HES) data are combined with Cancer Waiting Times (CWT) data, data from the cancer screening programmes and cancer registration data from the National Cancer Data Repository (NCDR). Using these datasets every case of cancer registered in England which was diagnosed in 2006-2013 is categorised into one of eight ‘Routes to Diagnosis’.

The methodology is described in detail in the British Journal of Cancer article “Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets”.

Outputs available for the 2006-2013 iteration include:

  • Routes to Diagnosis 2006-2013 workbook (a):This spread sheet presents the key incidence and survival statistics from the Routes to Diagnosis work. Two types of data are presented; the percentage of total cancers that are diagnosed by each Route, and the relative survival for each Route. The user can select the cancer type of interest, the year of diagnosis or the survival period. Data are presented by sex, age group and deprivation quintile as well as by ethnicity for incidence.
  • Routes to Diagnosis 2006-2013 workbook (b):This spread sheet presents incidence metrics further broken down from the Routes to Diagnosis work. Three sets of data are presented; more detail for the percentage of cancers diagnosed by emergency Routes, results by Strategic Clinical Network (SCN) and results for four cancer sites by Clinical Commissioning Group (CCG).
  • Routes to Diagnosis 2006-2013: technical document: This document summarises the data sources and methodology used for this Routes to Diagnosis project.
  • Routes to Diagnosis 2006-2013 preliminary results short reportA short report looking at incidence data from the preliminary 2006-2013 results. The report gives the background to the work, and some initial results including an overview of the emergency presentation route. Note that cancer screening data for colorectal was not available at the time of publication, and as such the addition of these in future will impact the "all malignant neoplasms" group in the report. 

Results for the 2006-2013 study have fewer cases assigned to the “unknown” Route due to more complete HES data being available. Having an 8-year cohort to base results from has also an improved examination of time trends with changes between Routes becoming more evident.

RtD_2006_2013_EP_trend

Different cancer types show substantial differences between the proportions of cases that present by each Route. Patients presenting via Emergency Routes have substantially lower one-year relative survival. Cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to explore possible reasons for delayed diagnosis, direct the focus of early diagnosis initiatives and identify areas for further research.

Site-Specific Data Briefings 2006-2013

For the 2006-2013 results a data briefing has been produced for each site, containing a summary of incidence and survival breakdowns from the full data workbook.

Routes to Diagnosis related studies

Routes to diagnosis of cancer by stage, 2012-2013

This spread sheet provides the proportion of cancer cases by stage at diagnosis for patients presenting via each of the six presentation routes, for 2012, 2013 and 2012-2013 combined. Detailed information is provided for 10 cancer sites.

Data are stratified by sex, age, socio-economic deprivation quintile and ethnicity. For further information on the methods and caveats, please see the workbook.

Other publications include:

Previous Routes to Diagnosis Outputs

  • Routes to diagnosis 2006-2010 workbook (a):This spread sheet presents the key incidence and survival statistics from the Routes to Diagnosis work. Two types of data are presented; the percentage of total cancers that are diagnosed by each Route, and the relative survival for each Route. The user can select the cancer type of interest, the year of diagnosis or the survival period. Data are presented by sex, age group and deprivation quintile as well as by ethnicity for incidence. 
  • Routes to diagnosis 2006-2010 workbook (b):This spread sheet presents incidence metrics further broken down from the Routes to Diagnosis work. Three sets of data are presented; more detail for the percentage of cancers diagnosed by emergency Routes, results by Strategic Clinical Network (SCN) and results for four cancer sites by Clinical Commissioning Group (CCG).
  • Routes to Diagnosis 2006-2010: technical document: This document summarises the data sources and methodology used for this Routes to Diagnosis project.
  • Routes to diagnosis 2006-2008 NCIN Information supplement: This report summarises the Routes assigned for all English patients diagnosed with malignant cancers between 2006 and 2008. Results are broken down by cancer type, age group and deprivation quintile. Associated relative survival estimates are shown for 1, 3, 6, 9 and 12 month survival intervals with 12 month survival also broken down by age group.