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  • Usha Menon
    University College London
  • Peter Vedsted
    Aarhus University, Aarhus, Denmark
  • Alina Zalounina Falborg
    Aarhus University, Aarhus, Denmark
  • Henry Jensen
    Aarhus University, Aarhus, Denmark
  • Samantha Harrison
    Cancer Research UK
  • Irene Reguilon
    Cancer Research UK
  • Andriana Barisic
    Cancer Care Ontario
  • Rebecca J. Bergin
    University of Melbourne
  • David Brewster
    University of Edinburgh
  • John Butler
  • Odd Terje Brustugun
  • Oliver Bucher
  • Victoria Cairnduff
    Queens University Belfast
  • Anna T. Gavin
    Queens University Belfast
  • Eva Grunfeld
    Cancer Care Ontario
  • Elizabeth Harland
    Cancer Care Manitoba, Winnipeg
  • Jatinderpal Kalsi
  • Anne Kari Knudsen
    University of Oslo
  • Mats Lambe
    Karolinska Institute, Stockholm
  • Rebecca-Jane Law
  • Yulan Lin
    Oslo University Hospital
  • Martin Malmberg
    Lund University
  • Donna Turner
  • Richard Neal
    University of Leeds
  • Victoria White
    University of Melbourne
  • David Weller
    University of Edinburgh
  • ICBP Module 4 Working Group

OBJECTIVE: Differences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.

DESIGN: Newly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.

PARTICIPANTS: Consecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.

PRIMARY AND SECONDARY OUTCOME MEASURES: Interval lengths (days; primary), routes to diagnosis and symptoms (secondary).

RESULTS: With the exception of Denmark (-49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012-2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (-11 days) than Wales (20 days); Sweden had shorter (-20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (-13), Manitoba (-11), England (-9) and Northern Ireland (-4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.

CONCLUSION: There are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.

Original languageEnglish
Article numbere025895
Pages (from-to)e025895
JournalBMJ Open
Issue number11
Early online date27 Nov 2019
Publication statusPublished - 27 Nov 2019

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