title: Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers.
abstract: BACKGROUND
  Evidence is needed about the promptness of cancer diagnosis and associations between its measures.
  
  
  METHODS
  We analysed data from the National Audit of Cancer Diagnosis in Primary Care 2009-10 exploring the association between the interval from first symptomatic presentation to specialist referral (the primary care interval, or 'interval' hereafter) and the number of pre-referral consultations.
  
  
  RESULTS
  Among 13,035 patients with any of 18 different cancers, most (82%) were referred after 1 (58%) or 2 (25%) consultations (median intervals 0 and 15 days, respectively) while 9%, 4% and 5% patients required 3, 4 or 5+ consultations (median intervals 34, 47 and 97 days, respectively) (Spearman's r=0.70). The association was at least moderate for any cancer (Spearman's r range: 0.55 (prostate)-0.77 (brain)). Patients with cancers with a higher proportion of three or more pre-referral consultations typically also had longer median intervals (e.g., multiple myeloma) and vice versa (e.g., breast cancer).
  
  
  CONCLUSIONS
  The number of pre-referral consultations has construct validity as a measure of the primary care interval. Developing interventions to reduce the number of pre-referral consultations can help improve the timeliness of cancer diagnosis, and constitutes a priority for early diagnosis initiatives and research.
authors: Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK. gl290@medschl.cam.ac.uk
authors: G
authors: G
authors: Lyratzopoulos
authors: G A
authors: GA
authors: Abel
authors: S
authors: S
authors: McPhail
authors: R D
authors: RD
authors: Neal
authors: G P
authors: GP
authors: Rubin
mesh_terms: D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008485:Medical Audit; D009369:Neoplasms / Q000175:diagnosis*; D011320:Primary Health Care; D011379:Prognosis; D012017:Referral and Consultation
references: Br J Gen Pract. 2006 Nov;56(532):863-8
references: 17132354
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S102-9
references: 19956153
references: Br J Gen Pract. 2012 Jan;62(594):e29-37
references: 22520670
references: Br J Cancer. 2011 Mar 15;104(6):934-40
references: 21364593
references: Br J Cancer. 2005 Jun 6;92(11):1971-5
references: 15900296
references: Br J Cancer. 2012 Mar 27;106(7):1262-7
references: 22415239
references: Lancet Oncol. 2012 Apr;13(4):353-65
references: 22365494
references: Lancet. 1999 Apr 3;353(9159):1119-26
references: 10209974
references: Br J Cancer. 2005 Jun 6;92(11):1959-70
references: 15870714
references: BMC Health Serv Res. 2011 Oct 25;11:284
references: 22027084
references: Lancet Oncol. 2012 Jul;13(7):I
references: 22748254
references: Br J Cancer. 2009 Dec 3;101 Suppl 2:S80-6
references: 19956169