Why can't we improve the timeliness of cancer diagnosis in children, teenagers, and young adults?

Fern, Lorna A; Birch, Rebecca; Whelan, Jeremy; Cooke, Mathew; Sutton, Stephen; Neal, Richard D; Gerrand, Craig; Hubbard, Gill; Smith, Sam; Lethaby, Chris; Dommett, Rachel

doi:10.1136/bmj.f6493

Cited by 26 publications

(26 citation statements)

References 12 publications

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“…This is particularly relevant to TYA. As TYA have less experience of medical encounters and greater embarrassment when reporting symptoms, the proportion giving non-specific descriptions may be increased [44,45]. If this is coupled with a low clinical suspicion (driven by the epidemiology), long delays would then occur for cancers where non-specific symptoms are reported.…”

Section: Discussionmentioning

confidence: 99%

Pathways to Diagnosis for Teenagers and Young Adults with Cancer in European Nations: A Pilot Study

Smith

Pini

Ferrari

et al. 2018

Journal of Adolescent and Young Adult Oncology

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Section: Discussionmentioning

confidence: 99%

Pathways to Diagnosis for Teenagers and Young Adults with Cancer in European Nations: A Pilot Study

Smith

Pini

Ferrari

et al. 2018

Journal of Adolescent and Young Adult Oncology

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“…As suspecting the diagnosis of cancer in patients who are younger is typically harder than in those who are older, they may be more likely to be initially referred to specialist clinics, and progress to an emergency presentation through these clinics. 20,21 As more deprived patients presenting as emergencies were less likely to have been referred by their GP and more likely to have presented to A&E, help-seeking patterns among otherwise similar patients subsequently diagnosed with the same cancer seem to vary by socioeconomic status.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015

et al. 2019

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BackgroundDiagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to appreciate the critical role of general practice over time in diagnostic pathways for patients with cancer.AimTo examine sociodemographic, cancer site, and temporal associations with type of presentation among patients with cancer diagnosed as emergencies.Design and settingAnalysis of Routes to Diagnosis data, 2006–2015, for patients with cancer in England.MethodThe authors estimated adjusted proportions of emergency presentation after emergency GP referral (GP-EP) or presentation to accident and emergency (AE-EP), by patient sex, age, deprivation group, and year of diagnosis using multivariable regression.ResultsAmong 554 621 patients presenting as emergencies, 24% (n = 130 372) presented as GP-EP, 62% as AE-EP (n = 346 192), and 14% (n = 78 057) through Other-EP sub-routes. Patients presenting as emergencies were more likely to have been GP-referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder, or ovarian cancer, or acute leukaemia. During the study period the proportion and number of GP-EPs nearly halved (31%, n = 17 364, in 2006; 17%, n = 9155 in 2015), while that of AE-EP increased (55%, n = 31 049 to 68%, n = 36 868).ConclusionPatients presenting as emergencies with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (for example, pancreatic cancer manifesting as painless jaundice) are over-represented among cases whose emergency presentation involved GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of 2-week-wait GP referrals during the study period and reductions in emergency GP referrals.

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“…Concern has been expressed regarding the timely diagnosis of cancer in children and young people in this country 1. The 2 week fast track (2WFT) system is intended to help GPs identify features of childhood cancer, and mandates local hospital trusts with suitable specialists to see referred cases within 2 weeks.…”

mentioning

confidence: 99%

Suspected childhood cancer fast track: increasing referrals, diminishing returns

Bragonier

Cordey

2015

Arch Dis Child

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Why can't we improve the timeliness of cancer diagnosis in children, teenagers, and young adults?

Cited by 26 publications

References 12 publications

Pathways to Diagnosis for Teenagers and Young Adults with Cancer in European Nations: A Pilot Study

Pathways to Diagnosis for Teenagers and Young Adults with Cancer in European Nations: A Pilot Study

Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015

Suspected childhood cancer fast track: increasing referrals, diminishing returns

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