Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study

Late cancer diagnosis contributes to worse cancer survival rates, however cancer diagnosis is rarely straightforward. Concerns about potential diagnostic delays at the patient, doctor and system levels were raised, resulting in the implementation of urgent suspected cancer referral pathway in the UK. These pathways enable rapid access to a specialist opinion or diagnostic tests for patients with specified symptoms. Evidence shows time to diagnosis and start of treatment is shorter for patients referred urgently. However, there is significant variation in the use of urgent referral pathways between general practice (GP) practices in England. This study aimed to explore the association between use of urgent referral, cancer stage at diagnosis, and patient mortality for colorectal, lung, breast and prostate cancer. Records of 1.4 million patients diagnosed with cancer in England between 2011 and 2015 were examined, and found that cancer patients from the highest referring GP practices had a lower hazard of death. Furthermore, cancer patients from high referring practices had lower odds of late-stage diagnosis for individual cancer types, except for colorectal cancer. These findings demonstrate that higher GP practice use of referrals for suspected cancer is associated with lower cancer mortality, likely due to earlier diagnosis. This supports the move to lower referral thresholds and to increase use of urgent referral for suspected cancer.

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