Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey

Abstract

ObjectivesThe 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.DesignA 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.Participants2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.Primary and secondary outcome measuresAnalysis 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.Results4 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.ConclusionsWe 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.

International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data

“…20 However, the Scottish analysis only included referred cases and so adherence to nondefinitive and definitive actions other than referral were not included. 20 The findings presented here support the ICBP3 16 by suggesting that cancer guidelines may have a modifying effect on primary care practitioner desire to refer or undertake a definitive investigation.…”

“…• sampling methods between jurisdictions were variable; 16 • the response rate was low, ranging from 5.5% (England) to 45.6% (Manitoba); 16 • responders were not totally representative of the primary care practitioners in all jurisdictions; 16 • there is a risk that the UK researchers involved in this analysis have incorrectly interpreted each jurisdiction's guidelines;…”

“…The full results are published elsewhere; a positive correlation was found in each jurisdiction between the primary care practitioner's willingness to act definitively at an earlier stage of the scenarios and 1-year (and conditional 5-year) survival rates. 16 The researchers of this study wanted to explore international variations in cancerspecific diagnostic guidance adherence by primary care practitioners. As such, the aim of this study was to:…”

Survival of ovarian cancer patients in Denmark: Results from the Danish gynaecological cancer group (DGCG) database, 1995–2012

“…However, diagnostic delay due to different attitudes and diagnostics practices among primary sector physicians has also been found to lead to lower survival. In Denmark, this is believed to be a major contributing factor to the poorer prognosis, at least up until 2010 [18].…”

New NICE guidance on diagnosing cancer in general practice

“…The International Cancer Benchmarking Partnership Module 3 study suggests that GPs in England and Wales have higher thresholds to investigate people with cancer symptoms than GPs from Australia and Canada, where cancer survival rates are better. 13 If the NICE guidelines are implemented successfully they could increase timely cancer diagnosis and, more importantly, reduce disparities in cancer survival between England and other developed nations.…”