期刊
BMJ OPEN
卷 8, 期 11, 页码 -出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2018-023870
关键词
health policy; organisation of health services; international health services; gastrointestinal tumours; epidemiology
资金
- CancerCare Manitoba
- Cancer Care Ontario
- Canadian Partnership Against Cancer (CPAC)
- Cancer Council Victoria
- Cancer Research Wales
- Cancer Research UK
- Danish Cancer Society
- Danish Health and Medicines Authority
- European Palliative Care Research Centre (PRC)
- Norwegian University of Science and Technology (NTNU)
- Northern Ireland Guidelines Audit and Implementation Network (GAIN)
- Macmillan Cancer Support
- National Cancer Action Team
- NHS England
- Northern Ireland Cancer Registry - Public Health Agency NI
- Norwegian Directorate of Health
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Denmark
- Scottish Government
- Swedish Association of Local Authorities and Regions
- University College London and NIHR Biomedical Research Centre at University College London NHS Foundation Trust
- University of Edinburgh
- Victorian Department of Health and Human Services
- Welsh Government
Objective International differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia). Design Patients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; 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. Participants A total of 14664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses. Primary and secondary outcome measures Interval lengths in days (primary), reported patient symptoms (secondary). Results The main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was bleeding/blood in stool'. The median intervals between jurisdictions 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 significantly alter the overall results. Conclusion ICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.
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