Cancer diagnostic pathways

To understand variation in cancer diagnostic pathways and to plan service improvements, NDRS studies diagnostic pathways using cancer registration data, along with Cancer Waiting Times (CWT) data, the Diagnostic Imaging Dataset (DID) and Hospital Episode Statistics (HES).

The NHS in England has several targets intended to ensure all patients have timely access to cancer services, diagnosis and treatments. These are targets for the maximum length of time that individuals with suspected cancer or diagnosed cancer should wait to be seen or treated. They are known as the Cancer Waiting Times (CWT) targets. 

Across the patient pathway, these targets include:

• the length of time people with possible cancer symptoms should wait to be seen
• the length of time people with symptoms wait to have a confirmation of cancer or have cancer ruled out
• the length of time patients diagnosed with cancer should wait for treatment

Cancer teams in the NHS work towards providing care within the CWT target waiting times. The CWT data set, officially the National Cancer Waiting Times Monitoring Data Set, records a range of information related to these waiting times targets and is collected to monitor whether cancer teams in the NHS are meeting these NHS targets. To find out more:

• view the data dictionary to see the information collected for the National Cancer Waiting Times Monitoring Data Set.
• access NHS England's National Statistics on waiting times for suspected and diagnosed cancer patients. There are monthly, quarterly and annual reports and the data is available nationally or can be split by commissioner and by provider.
• the Cancer Waiting Times Data Collection page for more information about when and how the data is collected.

Visit the Diagnostic imaging data page to find out more about this data.

Urgent suspected cancer (USC) referrals are used for people with possible cancer symptoms, to refer them to secondary care for investigation and possible diagnosis. USC referrals are commonly known as two-week wait referrals due to the CWT target that, within two weeks of being referred from their GP, individuals should be seen by a specialist in secondary care.

Using the CWT data, NDRS publishes an interactive tool presenting important information, not otherwise available, on frequency and variation in the use of USC referrals and about their contribution to diagnostic pathways. This includes breakdown of some key metrics by referral or cancer type, by demographic groups (gender, age, deprivation and ethnicity) and for a range of NHS geographies.

The metrics included in the tool are:

• crude referral rate which is the number of urgent suspected cancer referrals multiplied by 100,000 divided by the population
• conversion rate which is the percentage of urgent suspected cancer referrals which result in a diagnosis of cancer
• detection rate which is the percentage of cases recorded in the CWT data as receiving a first treatment for cancer which resulted from an urgent suspected cancer referral

View the NDRS interactive tool via the CancerData platform, for data showing the frequency of USC referrals and their contribution to diagnostic pathways.

In partnership with Cancer Research UK (CRUK), NDRS published an interactive tool presenting, for the first time, population-based statistics on the length of Secondary Care Diagnostic Interval (SCDI) for patients in England diagnosed with one of twenty-five cancer sites in 2014-2015.

The SCDI is defined as the time, in days, between a patient's first event with secondary care and their diagnosis date. It is derived from cancer registration, CWT, DID and HES data. The patient’s first event is defined as the earliest occurring of the following four event types, within the 6 months immediately preceding diagnosis:

• referral onto an urgent suspected cancer pathway
• referral to secondary care appointment
• secondary care appointment
• relevant diagnostic test appointment in secondary care

The interactive tool can be used to explore variation in SCDI interval length by demographic factors and geography, either for all routes to diagnosis combined or individually for the three most common routes to diagnosis: Emergency Presentation, Two Week Wait, and Routine GP referral.

View the NDRS interactive tool via the CancerData platform, for data showing variation in the secondary care diagnostic interval (this link opens in a new window).

In partnership with Cancer Alliance Data, Evidence and Analysis Service (CADEAS), NDRS published an interactive tool presenting national data on the median time taken, in days, for patients to be seen for their first treatment following a referral, for patients diagnosed with one of fifteen cancers between 2013 and 2018.

The median time taken from referral to first treatment is derived from a number of dates recorded in the cancer registration and CWT data, and is stratified into four intervals within the patient pathway:

• referral to first seen in secondary care
• first seen in secondary care to diagnosis
• diagnosis to first multidisciplinary team (MDT) meeting
• MDT meeting to treatment start date

The interactive tool can be used to explore variation in median pathway lengths, by socio-demographic factors, stage at diagnosis, route to diagnosis, and geography.

View the NDRS interactive tool via the CancerData platform, for data showing variation in the median pathway lengths.

NDRS also publishes information on urgent suspected cancer referrals, from the CWT data, in the Cancer Services profiles, which present data by General Practitioner (GP) practice and other NHS geographies.

Find out more about the Cancer Services Profiles by visiting the Cancer and primary care page.