Primary Care Medicine, North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK.
North Wales Centre for Primary Care Research, Bangor University, Wrexham Technology Park, Wrexham LL13 7YP, UK.
Br J Cancer. 2014 Feb 4;110(3):584-92. doi: 10.1038/bjc.2013.791. Epub 2013 Dec 24.
The primary aim was to use routine data to compare cancer diagnostic intervals before and after implementation of the 2005 NICE Referral Guidelines for Suspected Cancer. The secondary aim was to compare change in diagnostic intervals across different categories of presenting symptoms.
Using data from the General Practice Research Database, we analysed patients with one of 15 cancers diagnosed in either 2001-2002 or 2007-2008. Putative symptom lists for each cancer were classified into whether or not they qualified for urgent referral under NICE guidelines. Diagnostic interval (duration from first presented symptom to date of diagnosis in primary care records) was compared between the two cohorts.
In total, 37,588 patients had a new diagnosis of cancer and of these 20,535 (54.6%) had a recorded symptom in the year prior to diagnosis and were included in the analysis. The overall mean diagnostic interval fell by 5.4 days (95% CI: 2.4-8.5; P<0.001) between 2001-2002 and 2007-2008. There was evidence of significant reductions for the following cancers: (mean, 95% confidence interval) kidney (20.4 days, -0.5 to 41.5; P=0.05), head and neck (21.2 days, 0.2-41.6; P=0.04), bladder (16.4 days, 6.6-26.5; P≤0.001), colorectal (9.0 days, 3.2-14.8; P=0.002), oesophageal (13.1 days, 3.0-24.1; P=0.006) and pancreatic (12.6 days, 0.2-24.6; P=0.04). Patients who presented with NICE-qualifying symptoms had shorter diagnostic intervals than those who did not (all cancers in both cohorts). For the 2007-2008 cohort, the cancers with the shortest median diagnostic intervals were breast (26 days) and testicular (44 days); the highest were myeloma (156 days) and lung (112 days). The values for the 90th centiles of the distributions remain very high for some cancers. Tests of interaction provided little evidence of differences in change in mean diagnostic intervals between those who did and did not present with symptoms specifically cited in the NICE Guideline as requiring urgent referral.
We suggest that the implementation of the 2005 NICE Guidelines may have contributed to this reduction in diagnostic intervals between 2001-2002 and 2007-2008. There remains considerable scope to achieve more timely cancer diagnosis, with the ultimate aim of improving cancer outcomes.
本研究旨在利用常规数据比较 2005 年 NICE 疑似癌症转诊指南实施前后的癌症诊断间隔。次要目标是比较不同表现症状类别之间的诊断间隔变化。
使用来自一般实践研究数据库的数据，我们分析了在 2001-2002 年或 2007-2008 年诊断出的 15 种癌症之一的患者。根据 NICE 指南，将每种癌症的可疑症状列表分为是否符合紧急转诊标准。比较了两个队列中诊断间隔（从首次出现症状到初级保健记录中诊断日期的时间）。
共有 37588 名患者被新诊断出患有癌症，其中 20535 名（54.6%）在诊断前一年有记录的症状，并纳入分析。2001-2002 年至 2007-2008 年期间，整体平均诊断间隔缩短了 5.4 天（95%置信区间：2.4-8.5；P<0.001）。以下癌症有明显的减少：（平均，95%置信区间）肾脏（20.4 天，-0.5 至 41.5；P=0.05）、头颈部（21.2 天，0.2-41.6；P=0.04）、膀胱（16.4 天，6.6-26.5；P≤0.001）、结直肠癌（9.0 天，3.2-14.8；P=0.002）、食管癌（13.1 天，3.0-24.1；P=0.006）和胰腺癌（12.6 天，0.2-24.6；P=0.04）。表现出符合 NICE 标准的症状的患者比没有表现出症状的患者诊断间隔更短（两个队列中的所有癌症）。对于 2007-2008 队列，中位数诊断间隔最短的癌症是乳腺癌（26 天）和睾丸癌（44 天）；最高的是骨髓瘤（156 天）和肺癌（112 天）。一些癌症的分布第 90 百分位数的值仍然非常高。交互检验提供的证据表明，表现出 NICE 指南中明确指出需要紧急转诊的症状的患者与没有表现出症状的患者之间，平均诊断间隔变化没有差异。
我们认为 2005 年 NICE 指南的实施可能促成了 2001-2002 年至 2007-2008 年之间诊断间隔的缩短。在实现更及时的癌症诊断方面仍有很大的空间，最终目标是改善癌症结果。
