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BMJ Open. 2018 Nov 27;8(11):e023870. doi: 10.1136/bmjopen-2018-023870.

Diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions; findings from a cross-sectional study from the International Cancer Benchmarking Partnership (ICBP).

Author information

1
MRC Clinical Trials Unit and Instittue of Clinical Trials and Methodology, University College London, London, UK.
2
Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
3
Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
4
European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
5
Centre for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.
6
Department of General Practice, University of Melbourne, Melbourne, Australia.
7
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
8
Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, UK.
9
Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK.
10
Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
11
Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
12
Regional Cancer Center Uppsala and Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden.
13
North Wales Centre for Primary Care Research, Bangor Institute for Health and Medical Research, Bangor University, Bangor, UK.
14
Department of Oncology, Lund University Hospital, Lund, Sweden.
15
Population Oncology, Cancer Care Manitoba, Winnipeg, Canada.
16
Academic Unit of Primary Care, University of Leeds, Leeds, UK.
17
School of Psychology, Deakin University School of Psychology, Burwood, Victoria, Australia.
18
Policy and Information, Cancer Research UK, London, UK.
#
Contributed equally

Abstract

OBJECTIVE:

International differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia).

DESIGN:

Patients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients' primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression.

PARTICIPANTS:

A total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Interval lengths in days (primary), reported patient symptoms (secondary).

RESULTS:

The main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was 'bleeding/blood in stool'. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results.

CONCLUSION:

ICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.

KEYWORDS:

epidemiology; gastrointestinal tumours; health policy; international health services; organisation of health services

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