Pathways to a Cancer Diagnosis in Northern Ireland
Research type
Research Study
Full title
Pathways to a Cancer Diagnosis: Monitoring variation in the patient journey across Northern Ireland
IRAS ID
247948
Contact name
Finian Bannon
Contact email
Sponsor organisation
Queen's University Belfast
Duration of Study in the UK
1 years, 2 months, 31 days
Research summary
Research Summary:
Although cancer patient survival in Northern Ireland is improving, it remains low internationally. Many “late presentation” cases are diagnosed when cancer has already spread to other parts of the body (Stage IV cancer); this represents almost 1 in 5 cancers in Northern Ireland.
Public Health England have been monitoring the “routes” by which cancer is detected for a number of years, using a methodology based on using routinely collected data sources to work backwards to examine the sequence of events that led to a cancer diagnosis. Based on this analysis they classified patients into eight broad routes. These range from the earliest possible intervention which is “Screen Detected” to “Death Certificate Only”.
The primary aim of the study is to explore whether robust measures for routes-to-diagnosis can be reproduced for Northern Ireland.
By combining Northern Ireland equivalent datasets in a secure environment we aim to apply the Public Health England Routes-to-Diagnosis Algorithm and for the first time produce a comprehensive overview of the Routes-to-Diagnosis for cancers detected between 2009-2016 in Northern Ireland.
The second aim of this study is to measure statistical variation across Northern Ireland in patients moving through different routes-to-diagnosis. Measures will be presented on funnel plots presented in an interactive tool whereby varying cancer sites, health geographies (from GP practice level up), and time periods can be explored.It is hoped that reliable evidence of variation across health geographies will stimulate further research and/or interventions to increase the number of patients moving through routes-to-diagnosis that are associated with better prognosis.
Summary of results:
‘Routes-to-diagnosis’ analysis is a novel methodology developed by Public Health England, which classifies cancer patients based on the health care events that lead to their diagnosis (eg cancer screening, GP referral, emergency presentation). Such an approach can help transform the care pathway by focusing attention on promoting symptom awareness, early diagnosis and effective treatment.
This project applied the routes-to-diagnosis methodology to Northern Ireland datasets for cancer patients diagnosed from 2012 to 2016. A comprehensive report providing analysis across all the main cancer sites broken down by a range of factors, including gender, age, deprivation, disease stage and survival, was produced.
Comparisons with England revealed that although rates of screening and emergency presentation were similar, significant numbers of patients still enter the health system through emergency routes and with late-stage presentation in Northern Ireland.
An intuitive interactive online tool was developed to give health service practitioners access to detailed information by selecting data breakdowns, tables and graphs, and exploring findings on less common cancers. Although still a prototype, the tool received positive feedback on its ease-of-use for data comparison.
Despite encountering data quality issues, the project team greatly enhanced their analytical capabilities, particularly in the use of R Studio for producing data visualisations, and developed recommendations on improvements to methodology and interpretation for any future iterations of their work.
This sophisticated analysis clearly highlights the need for further investigation to promote earlier cancer diagnosis and provides an evidence base that will inform the evaluation of cancer service delivery in Northern Ireland, including the new 10-year cancer strategy.
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REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
18/YH/0205
Date of REC Opinion
21 May 2018
REC opinion
Favourable Opinion