Evidence map›Paper›PMID 29182609›Full record

ArticleBritish journal of cancer2018

Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites.

Y Zhou, S C Mendonca, G A Abel, W Hamilton, F M Walter, S Johnson, J Shelton, L Elliss-Brookes, S McPhail, G Lyratzopoulos

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of cancer, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 7 pooled it
2.6field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 7 syntheses or guidelines pooled it, 89 citations in OpenAlex.

  1. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies.International journal of environmental research and public health · 2022
    Pooled it
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  3. Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
    Pooled it
  4. Pooled it
  5. Interventions to reduce the time to diagnosis of brain tumours.The Cochrane database of systematic reviews · 2020
    Pooled it
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  7. Direct access cancer testing in primary care: a systematic review of use and clinical outcomes.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018
    Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Y ZhouCambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge CB1 8RN, UK.
S C MendoncaCambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge CB1 8RN, UK.
G A AbelUniversity of Exeter Medical School (Primary Care), Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK.
W HamiltonUniversity of Exeter Medical School (Primary Care), Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK.
F M WalterCambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge CB1 8RN, UK.
S JohnsonNational Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
J SheltonCancer Research UK, Angel Building 407 St John Street, London EC1V 4AD, UK.
L Elliss-BrookesNational Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
S McPhailNational Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
G LyratzopoulosCambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge CB1 8RN, UK.
National Cancer Registration Service · GBUniversity of Cambridge · GBUniversity of Exeter · GBCancer Research UK · GB

Funding

Cancer Research UK 18180Cancer Research UK C18081/A18180Wellcome Trust
6 · The paper itself

Abstract

backgroundIn England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups.

methodsWe examined data from 669 220 patients with 35 cancers diagnosed in 2006-2010 following either fast-track or 'routine' primary-to-secondary care referrals using 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer.

resultsThere were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer.

conclusionsFast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for 'alarm' symptoms are needed to improve diagnostic timeliness.

Indexed as

Referral and ConsultationAge FactorsEarly Detection of CancerEvidence-Based MedicineFemaleHumansMaleNeoplasmsOdds RatioRegression AnalysisSex Factors

Identifiers

PMID29182609
PMCPMC5765227
OpenAlexW2770226960

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.