Diagnostic routes and time intervals for ovarian cancer in nine international jurisdictions; findings from the International Cancer Benchmarking Partnership (ICBP)

BACKGROUND

International Cancer Benchmarking Partnership Module 4 reports the first international comparison of ovarian cancer (OC) diagnosis routes and intervals (symptom onset to treatment start), which may inform previously reported variations in survival and stage.

METHODS

Data were collated from 1110 newly diagnosed OC patients aged >40 surveyed between 2013 and 2015 across five countries (51-272 per jurisdiction), their primary-care physicians (PCPs) and cancer treatment specialists, supplement by treatment records or clinical databases. Diagnosis routes and time interval differences using quantile regression with reference to Denmark (largest survey response) were calculated.

RESULTS

There were no significant jurisdictional differences in the proportion diagnosed with symptoms on the Goff Symptom Index (53%; P = 0.179) or National Institute for Health and Care Excellence NG12 guidelines (62%; P = 0.946). Though the main diagnosis route consistently involved primary-care presentation (63-86%; P = 0.068), onward urgent referral rates varied significantly (29-79%; P < 0.001). In most jurisdictions, diagnostic intervals were generally shorter and other intervals, in particular, treatment longer compared to Denmark.

CONCLUSION

This study highlights key intervals in the diagnostic pathway where improvements could be made. It provides the opportunity to consider the systems and approaches across different jurisdictions that might allow for more timely ovarian cancer diagnosis and treatment.

A comparative analysis: international variation in PET-CT service provision in oncology-an International Cancer Benchmarking Partnership study

Objective

To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services.

Design

Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions.

Setting

PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK).

Participants

None.

Intervention(s)

None.

Main Outcome Measure(s)

None.

Results

PET-CT service provision has grown over the period 2006–2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied.

Conclusions

Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services.

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

OBJECTIVE

Differences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.

DESIGN

Newly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.

PARTICIPANTS

Consecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.

PRIMARY AND SECONDARY OUTCOME MEASURES

Interval lengths (days; primary), routes to diagnosis and symptoms (secondary).

RESULTS

With the exception of Denmark (-49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012-2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (-11 days) than Wales (20 days); Sweden had shorter (-20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (-13), Manitoba (-11), England (-9) and Northern Ireland (-4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.

CONCLUSION

There are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.

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)

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.

Understanding International Variation in Cancer-Specific 'Access to Diagnostics' Data and Steps Toward Cohesive Cancer Intelligence Frameworks: An International Cancer Benchmarking Partnership (ICBP) Study

Background: Robust and accurate data underpins cancer research, planning, control and comparisons; it shapes the policies and structures of health systems internationally. Access to diagnostics is crucial for timely cancer diagnosis and treatment planning as previous evidence has shown that delays in diagnosis can impact cancer outcomes. It is possible that differences in cancer outcomes internationally are a consequence of differing levels of access to diagnostic tests. By better understanding variation in this access, this relationship can be further explored. However, diagnostic data availability is not currently well documented. Aim: The primary goal of this exercise was to identify already existing routine or national datasets exploring 'access' variables relating to diagnostics for imaging and endoscopy tests. These access variables included capacity, use, workforce, location and financial factors, and where possible specific to the cancer population. Secondly, to address what high-income countries need to improve to fulfill the existing criteria for 'cancer intelligence frameworks', such as those set out by the National Health Service in England. Methods: Mixed methods including online searches and discussion with local contacts were used to explore key diagnostic data variables across the seven participating countries of ICBP phase 2 (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). Results: Gaps and inconsistencies in diagnostics data were identified in each country. These key issues make comparisons within and between countries challenging: inconsistent definitions, collection at different levels within a health system, and queries about the coverage, reliability, and linkage of data (especially for cancer) were raised. The usage and allocation of workforce is also poorly documented, and a lack of appropriate infrastructure raised as a key barrier to better collection of data. Currently, most countries do not have a centralised data collection organization, and there are no international or standardized definitions for the diagnostic data that should be collected and could be compared. Conclusion: Health data are disparately collected internationally, with little diagnostics data that can be linked to cancer populations. The data sources and gaps identified add weight to existing efforts to improve data collections and health service planning. International agreement on the key performance indicators, their definitions and how best to organize collected data are required to address gaps and enable robust comparisons. These definitions and an understanding of best practice will be useful for middle- and low-income countries who want to develop or start collecting cancer-specific data. Existing 'cancer intelligence' frameworks could be adapted for international use, but rely on the agreement and adoption of standardized definitions and metrics for the cancer population.