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National Audit of Cancer Diagnosis in Primary Care: 2009/10

National Audit of Cancer Diagnosis in Primary Care: 2009/10. Greg Rubin, Sean McPhail, Kathy Elliott . Project Overview. Background Response to 2007 Cancer Reform Strategy Part of the National Awareness and Early Diagnosis Initiative Aims

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National Audit of Cancer Diagnosis in Primary Care: 2009/10

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  1. National Audit of Cancer Diagnosis in Primary Care: 2009/10 Greg Rubin, Sean McPhail, Kathy Elliott

  2. Project Overview • Background • Response to 2007 Cancer Reform Strategy • Part of the National Awareness and Early Diagnosis Initiative • Aims • To give insights into the primary care diagnostic pathway for patients with cancer. • To inform professional and practice development and the commissioning process for cancer.

  3. Data collection • 20 / 28 Cancer Networks in England, 1170 / 8245 practices, 18,879 patients with cancer • Data for each patient recorded on standard template (RCGP) • Target period 6-12 months in 2008–2009 • Data validated by PCT or Cancer Network clinical lead • Anonymised (by patient and practice) data submitted • Data cleaned & merged into unified national ‘pot’ by NCIN • Exclusions: screen-detected cases, non-melanoma skin cancer & in-situ tumours.

  4. Cases included in audit

  5. Number of GP consultations before specialist referral • Excluding those with 0 consultations, 73.2% of patients consulted 1 or 2 times before referral • Cancer sites for which >20% of patients had 3 or more consultations: • Lung, lymphoma, ovary, pancreas, and stomach

  6. Routes to diagnosis

  7. Patient Interval • Primary care interval Referral interval

  8. Cancer stage at diagnosis

  9. Investigations ordered • Fraction of patients diagnosed with each tumour type that have specified investigation (i.e. 74.1% of prostate cancer patients have a blood test). • (Multiple investigations in a single patient may be counted more than once.)

  10. Type of investigations that would have changed GP management

  11. Cases (%) in which access to investigation would have changed GP management (95% confidence intervals are shown)

  12. Summary • This was a very large national audit, well supported by general practitioners. • Over two thirds of all patients were referred to a specialist within a month of their first consultation. • Of those patients who consulted a GP, three quarters were referred after only one or two attendances. • People who are housebound, have communication difficulties or who present as an emergency tend to have more advanced cancer at diagnosis. • Better access to investigations would change the GP’s management in 6 % of all cases, but more so for brain, ovary, pancreas and kidney cancers.

  13. Thanks to all the participating practices and to the Audit Advisory Group g.p.rubin@durham.ac.uk http://www.dur.ac.uk/school.health/erdu/cancer_audit/

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