Routes to diagnosis

Introduction

This tool contains information on Routes to Diagnosis, a method of identifying and categorising key events in the healthcare system that lead to a patients diagnosis of cancer.

Compared to the European average, cancer survival in England is low. Studies suggested this difference could be largely due to later diagnosis when cancers have progressed to a more advanced stage and are harder to treat. In 2012, the award-winning Routes to Diagnosis study was published in an attempt to shed more light on patients journeys to diagnosis to see what could be improved. The study found large differences in how patients were diagnosed and large variation in survival between these groups.

The tool presents the latest results for Routes to Diagnosis and includes the following pages:

Accessibility: Gives the user the ability to select an accessible colour palette.
Introduction: An overview of the tool and links to previous outputs.
Methodology: A summary of the Routes to Diagnosis methodology and full details of the factors included in the tool.
Incidence:
- Longer time trend: Results presented for each Route and year since 2006 for colorectal, female breast, lung and prostate cancers.
- Demographics: Results presented for each Route by cancer site, year and demographic factor (age, deprivation quintile, gender and ethnicity).
- Stage: Results presented for each Route by cancer site, year and stage at diagnosis.
- Emergency Presentations: Results presented for each Emergency Presentation Route by cancer site and year.
Survival:
- Gender: 1-year age-standardised survival estimates presented for each Route by gender and cancer site.
- Years since diagnosis: 1- to 5-year age-standardised survival estimates presented by Route.
- Age: 1- to 5-year non-standardised survival estimates presented by Route and age.
- Trends: Trends in 1- and 5-year non-standardised survival estimates presented by Route and year.
- Deprivation: 1-year non-standardised survival estimates by Route and deprivation quintile for selected cancer sites.
- Stage: 1-year non-standardised survival estimates by Route and Stage for selected cancer sites.
- Tables: Survival estimates presented by Route, cancer site and years since diagnosis.
Downloads: Links to download all the data in the tool.
Update Log: A summary of updates for each release.

Acknowledgement

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS England.

Purpose

The Routes to Diagnosis project supports early diagnosis initiatives whose aim is to promote earlier diagnosis of cancer and thereby improve survival rates and reduce cancer mortality. The project was the first to explore the feasibility of using routine data to evaluate how cancer patients access the health service for diagnosis and whether the routes are associated with survival differences. This in turn can be used to inform strategy in terms of improved patient education regarding signs and symptoms, medical practitioner education, and routes of referral. The outputs help to inform awareness and early diagnosis initiatives locally and nationally, ideally resulting in more appropriate referrals and earlier diagnosis of cancer as well as eventually improving the cost effectiveness of NHS.

Methodology

Administrative Hospital Episode Statistics (HES) data are combined with Cancer Waiting Times (CWT) data, data from national cancer screening programmes and national cancer registration data. Using these data sets, every case of cancer registered in England diagnosed from 2006 is categorised into one of eight 'Routes to Diagnosis' listed below:

Route	Definition
GP referral	Routine and urgent referrals where the patient was not referred under the TWW referral route.
Urgent Suspected Cancer (USC)	Urgent GP referrals with a suspicion of cancer (previously known as Two-week wait/TWW).
Emergency presentation	An emergency route via accident and emergency (A&E), emergency GP referral, emergency transfer, emergency admission or attendance.
Other outpatient	An elective route starting with an outpatient appointment that is either a self-referral, consultant to consultant referral, other or unknown referral (excludes patients originally referred under the TWW referral route).
Screen-detected	Flagged by the cancer registry as detected via the breast, bowel or cervical screening programmes.
Inpatient elective	No earlier information can be found prior to admission from a waiting list, booked or planned.
DCO	Diagnosis by death certificate only.
Unknown	No relevant data available from Inpatient or Outpatient HES, National Cancer Waiting Times or National Screening Programmes.

The full methodology is described in the British Journal of Cancer article, Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets, which was published in October 2012.

Release schedule

Please refer to the 'Update Log' tab within the dashboard for information on each release.

Feedback and support

The tool is produced by the National Disease Registration Service (NDRS). Please send any feedback or queries to [email protected]

Please do not include sensitive or patient identifiable information.

Downloads

To access the data used in the dashboard, please refer to the 'Downloads' tab within the dashboard.