Routes to Diagnosis
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 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 the NCIN data briefing: Routes to Diagnosis, in November 2010. Since then the methodology has been reviewed and the results have been updated to include patients diagnosed from 2006 to 2008. A series of publications are now available.
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 2006-2008 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”. A number of additional documents have been produced to aid interpretation of the Routes to Diagnosis results:
- 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.
- Routes to Diagnosis 2006-2008 workbook: This spread sheet presents the key statistics from the latest 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. Changing the cancer type in one sheet also changes the selected site in the other sheets.
Different cancer types show substantial differences between the proportion of cases that present by each Route, in reasonable agreement with previous clinical studies. 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.