A quarter of cancer patients experienced delays, which could
have been avoided, during the diagnostics, shows a recent study by Cancer
Research UK. One of the reasons were long waiting times for test results,
and this, in turn, was attributed to staff shortages.
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The study by Swann et al. (2019), The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients, was published in Cancer Epidemiology. It analysed data of around 14,300 people diagnosed with cancer in England in one year (2014).
The results show that for almost a quarter, or nearly 3,400 patients, the diagnosis was unnecessarily delayed with half of them waiting around two months longer to be diagnosed compared with those patients who did not experience an avoidable delay.
The researchers focused on three timeframes based on a patient’s interaction with their GP. They looked into whether the delay happened before a visit to GP, during the assessment process or after the GP had referred the patient to hospital. The major share of delays, 49%, happened during the second stage (assessment) including waiting for tests to be done and results to be sent back. Another 38% of delays fell into the post-referral period and the remaining 13% happened before the patient saw their GP.
Waiting times for tests were the cause of a quarter of all avoidable delays. Cancer Research UK considers this to be a consequence of staffing shortages among diagnostic staff in hospitals (National Audit Office 2019). Avoidable delays were also identified for cases when a GP could not immediately attribute a patient’s symptoms to cancer. One of the examples comes from myeloma diagnosing: its symptoms can be an indication of many other conditions which, ultimately, causes delays in identifying the disease. Similar causes apply to patients with pre-existing conditions, as their symptoms could be attributed to another health condition rather than cancer.
Ruth Swann, lead author and Cancer Research UK’s senior cancer information analyst, underscored the importance of ensuring there were no unnecessary waiting for a potential diagnosis. “Our research shows there’s a good opportunity to significantly reduce delays by cutting the time it takes for patients to have tests done. We need more research to develop and evaluate new diagnostic tests for patients with vague symptoms and a better way to manage them,” she said.
The numbers of patients referred to hospitals with suspected symptoms has been steadily rising over the last few years. Currently, more than 363,000 people are diagnosed with cancer each year in the UK, and this number is projected to increase to over 500,000 by 2035 (Smittenaar et al. 2016). However, hospitals often do not have the staff to deal with growing demand with 10% of diagnostics posts being vacant (Nuffield Trust 2019). “There simply aren’t enough people in the NHS to read scans or report tests swiftly,” said Sara Hiom, Cancer Research UK’s director of early diagnosis, adding that no one should have to wait for their cancer diagnosis longer than is absolutely necessary.
It is noted, however, that in comparison to 2014, the reference year for the research, the current referral pathways allow for earlier investigation and referral of patients.
National Audit Office (2019) NHS waiting times for elective and cancer treatment. Available from https://www.nao.org.uk/wp-content/uploads/2019/03/NHS-waiting-times-for-elective-and-cancer-treatment.pdf
Nuffield Trust (2019) Future supply of and demand for NHS staff (chart). Available from https://www.nuffieldtrust.org.uk/chart/future-supply-of-and-demand-for-nhs-staff
Smittenaar et al. (2016) Cancer Incidence and Mortality Projections in the UK until 2035. British Journal of Cancer, 115(9):1147–1155. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117795/
Swann et al. (2019) The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients. Cancer Epidemiology, in press.