title: Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey.
abstract: OBJECTIVE
  The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.
  
  
  METHODS
  A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.
  
  
  METHODS
  2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.
  
  
  METHODS
  Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.
  
  
  RESULTS
  4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.
  
  
  CONCLUSIONS
  We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.
authors.affiliation: Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Rose
authors.affiliation: School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, UK.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera-Salazar
authors.affiliation: Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Sigrun Saur
authors.initials: SS
authors.lastname: Almberg
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Andriana
authors.initials: A
authors.lastname: Barisic
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.affiliation: Knowledge Translation Research Network Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
authors.affiliation: School of Medicine, Dentistry and Biomedical Sciences-Centre for Public Health, Queen's University Belfast, Belfast, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Hart
authors.affiliation: North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.affiliation: Department of General Practice, Primary Health Care Research Evaluation and Development, Carlton, Victoria, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.affiliation: Division of Continuing Professional Development, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sisler
authors.affiliation: Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Konrad
authors.affiliation: Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Berit Skjødeberg
authors.initials: BS
authors.lastname: Toftegaard
authors.affiliation: Department of Clinical Sciences, Kronoberg County Research Council, Växjö, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Thulesius
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.affiliation: Department of Cancer Epidemiology, Public Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Young
authors.affiliation: Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
mesh_terms: D000704:Analysis of Variance; D001315:Australia / Q000453:epidemiology; D019985:Benchmarking; D002170:Canada / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D009664:Norway / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000401:mortality*; D011320:Primary Health Care; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D006113:United Kingdom
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; ONCOLOGY