title: For which cancers might patients benefit most from expedited symptomatic diagnosis? Construction of a ranking order by a modified Delphi technique.
abstract: BACKGROUND
  This study aimed to answer the question 'for which cancers, in a symptomatic patient, does expediting the diagnosis provide an improvement in mortality and/or morbidity?'
  
  
  METHODS
  An initial ranking was constructed from previous work identifying 'avoidable deaths' for 21 common cancers in the UK. In a two-round modified Delphi exercise, 22 experts, all experienced across multiple cancers, used an evidence pack summarising recent relevant publications and their own experience to adjust this ranking. Participants also answered on a Likert scale whether they anticipated mortality or morbidity benefits for each cancer from expedited diagnosis.
  
  
  RESULTS
  Substantial changes in ranking occurred in the Delphi exercise. Finally, expedited diagnosis was judged to provide the greatest mortality benefit in breast cancer, uterine cancer and melanoma, and least in brain and pancreatic cancers. Three cancers, prostate, brain and pancreas, attracted a median answer of 'disagree' to whether they expected mortality benefits from expedited diagnosis of symptomatic cancer.
  
  
  CONCLUSIONS
  Our results can guide future research, with emphasis given to studying interventions to improve symptomatic diagnosis of those cancers ranked highly. In contrast, research efforts for cancers with the lowest rankings could be re-directed towards alternative avenues more likely to yield benefit, such as screening or treatment.
authors.affiliation: University of Exeter, College House, St Luke's Campus, Exeter, EX2 4TE, UK. w.hamilton@exeter.ac.uk.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: University of Exeter, College House, St Luke's Campus, Exeter, EX2 4TE, UK. s.a.stapley@exeter.ac.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Stapley
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, UK. Christine.campbell@ed.ac.uk.
authors.forename: Christine
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK. y.lyratzopoulos@ucl.ac.uk.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. g.p.rubin@durham.ac.uk.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: School of Medicine, Pharmacy and Health, University of Durham, Wolfson Research Institute, Queen's Campus, Stockton on Tees, TS17 6BH, UK. r.neal@bangor.ac.uk.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
mesh_terms: D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D009026:Mortality; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D011379:Prognosis; D006113:United Kingdom / Q000453:epidemiology