Cancer remains one of the leading causes of death, claiming thousands of lives every year. Today, the results from the National Cancer Diagnosis Audit have been published, which details and reviews the current process of care for cancer patients from the initial presentation of symptoms through to diagnosis.
The first English National Audit of Cancer Diagnosis in Primary Care (NACDPC) was undertaken in 2009-10 in order to gain an understanding of the diagnostic process in primary care for patients subsequently diagnosed with cancer.
It included information on 18,879 patients diagnosed with cancer, identified from the registers of nearly 1200 practices, and provided detailed insights into the primary care pathway to cancer diagnosis.
The work underpinned a range of subsequent quality improvement initiatives led by the National Cancer Action Team, such as the Achieving World Class Cancer Outcomes Cancer Strategy 2015-2020.
Building on the 2009-10 NACDPC, a National Cancer Diagnosis Audit (NCDA) was formulated as a collaborative initiative between the key agencies in cancer diagnosis. The aim of the NCDA is to further understand the patient pathway from primary care to diagnosis and to highlight where improvements can be made, shortening the time interval from presentation to diagnosis.
Public Health England’s National Cancer Registration and Analysis Service (NCRAS) has been used to identify cases for the NCDA and primary care data was entered by GPs from participating practices. The data can be used with secondary care health data to understand the full cancer pathway for each patient in the NCDA.
The findings provide the most detailed and accurate picture to date about the diagnostic process in a large, representative, nationwide population of cancer patients.
Around 1 in 20 English general practices participated in the audit, providing opportunities for targeted analysis, reflective learning and action planning, along with detailed information about how cancer patients were diagnosed.
The NCDA has so far collected representative data from 6% of cancer registrations for 2014 (439 practices, which amount to 17,000 patients).
The data showed that most patients were referred promptly as generally patients first presenting with symptoms were referred within 5 days.
Information was also collected on co-morbidities before the patient was diagnosed with cancer, which can complicate diagnosis. This showed that only one quarter of patients had no co-morbidity and almost half of patients had two or more.
Alongside the information on co-morbidities the audit collected data on symptoms, investigations, and other patient factors. This can be used to better understand any difficulties in the diagnosis of cancer.
Areas for consideration
Ahead of the proposed 28-day faster diagnosis standard, the NCDA collected data on the time taken from referral from primary care to the patient being informed whether or not they have cancer.
Data from patients diagnosed in 2014 shows that there is variation by cancer type, and that the timeliness of this part of the pathway falls below 28-days in greater than 5% of cases. More analysis will need to be conducted of the NCDA findings to give insight into how this can be improved.
What this means for public health
This audit provides a rich source of data and an important benchmark by which the impact of current initiatives to improve cancer diagnosis are measured.
Individual practice feedback has already been provided and will support quality improvement initiatives, supported by a Quality Improvement toolkit developed by the Royal College of General Practitioners.
The NCDA also provides an opportunity to illustrate for the health sector a more detailed picture of the patient pathway from primary care to diagnosis and to highlight where improvements can be made.
These improvements will help the NHS to shorten the time interval from presentation to diagnosis.