Every day in Britain, over a thousand patients will be diagnosed with cancer. The UK falls behind most European countries in overall survival at 5 years – the key international metric of cancer outcomes. The reasons for this are complex but increasing evidence points to delay in the diagnostic process being the single most important factor. Data looking at 1-year survival shows even greater disparity from Europe. The 1-year survival statistic is mainly determined by delays in diagnosis and not the quality of oncological care for the four common cancers - breast, lung, prostate, and colon.
Cancer survival data are driven by the stage of the disease at presentation. For all four of the major cancers, Stage I disease has an over 90% 5-year survival. Stage 2 disease represents extension of the cancer to neighbouring lymph nodes or surrounding tissues, whilst stage 3 and 4 have increasing spread of cancer around the body. Staging systems are slightly different but the principle is the same. The outcome drops precipitously as the stage increases. Any delay is likely to result in upstage migration and, therefore, result in poorer survival for that cancer. More advanced cancer is more expensive to treat as it may involve significantly more radiotherapy and chemotherapy, and so achieving an earlier diagnosis could well be cost effective.
There are three causes for delay in cancer diagnostic pathways – the patient, the GP, and the hospital. The patient's decision to seek medical advice is the key entry point in any healthcare system. The threshold to seek help is complex and determined by multiple factors, including age, sex, ethnicity, socioeconomic status, and educational background. Educational campaigns have been successful in changing behaviours and are the responsibility of public health. But for many, access is becoming increasingly difficult and, therefore, the threshold to seeking help may be increased.
But there are currently significant problems in GP access for patients and getting an appointment may take several weeks. The 2-week wait system was introduced as a pragmatic measure in 2000. The problem is that cancer symptoms are vague and over the last 20 years multiple studies have demonstrated that only 25-27% of cancer patients are diagnosed through this pathway. Creating a fast track in a resource-constrained diagnostic environment also reduces the speed of the routine pathway so may not necessarily enhance the overall group. A novel approach needs to be developed to bypass the delays inherent in current pathways by empowering professionals to commission key diagnostic tests.