Objective: International differences in colorectal cancer (CRC) survival and stage at diagnosis have been widely reported. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership (ICBP) Module 4 reports the first international comparison of routes to diagnosis for CRC patients and the time intervals from symptom onset until the start of treatment(1). Data came from patients in ten jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia).
Design: CRC patients were identified via cancer registries. Data on symptomatic and screened patients were collected – with a target of 200 symptomatic patients. Questionnaire data from patients’ primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression.
Results: A total of 2,866 CRC patients diagnosed between 2013 and 2015 were included in the analyses. The main route to diagnosis was symptomatic presentation and the most commonly reported symptom was ‘bleeding/blood in stool’. The median intervals between jurisictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not alter the overall results. There were considerable absolute and relative differences between jurisdictions in time intervals from first symptom until treatment for CRC. These differences do not demonstrate an obvious relationship with survival differences between the jurisdictions.
Conclusion: Module 4 demonstrates important differences in time intervals between ten jurisdictions internationally. The main differences were found for structural parts of the pathway (e.g. those not relating to patient behaviours/actions). Further, there is a ‘tail’ of patients waiting many months longer for treatment of their cancer which may affect their outcomes. While our study highlights important international differences in routes to diagnosis, further research is needed to understand these differences, and elucidate the contribution of factors such as patient pathway guidance and implementation, and health system structures. Nevertheless, the data do provide important prompts for jurisdictions and suggest considerable room for improvement in some areas; they will also serve as a benchmark for measuring the effectiveness of future interventions.