Speeding up cancer diagnosis: how to break the 28-day barrier

January 19th, 2023. Go to post.

Standards introduced in October 2021 mandate that at least 75% of patients urgently referred by a GP[1] for suspected cancer should receive a diagnosis (or be cleared) within 28 days. In September 2022, however, 33% of them – 78,000 a month – did not receive a timely diagnosis. This reduces their chances of survival considerably by preventing prompt treatment.

As shown in Figure 1, from April 2021 to September 2022, the number of patients meeting the 28-day target has dropped from 73% to 67%, and the 75% target has yet to be met. This is likely due to the large increase in the number of referrals registered during the past months which is constraining diagnostics capacity (as discussed in our previous post).

This varies greatly by suspected cancer. The 28-day rate for breast and children’s cancer in September 2022 was in fact close to 90%, while for tumour sites such as gynaecology, skin, lower gastrointestinal and urology (including prostate) it was as low as 50%.

For urological malignancies, the failure to meet the 28-day diagnostic target has a significant impact on the 62-day treatment target. As shown in Figure 2, the longer the delay in obtaining a diagnosis, the more likely patients are to miss the 62-day treatment benchmark. This highlights the crucial importance of timely diagnosis in ensuring prompt and effective cancer treatment.
Furthermore, as the number of diagnostic tests administered increases, so does the proportion of patients who meet the 28-day diagnostic target. This correlation suggests that delays and capacity limitations in diagnostic testing are playing a key role in the decline of cancer care outcomes nationwide[2].

This is not going unnoticed, with trusts racing to implement a number of solutions to reduce pressure on hospitals and provide quicker access for patients. There are three broad groups of approaches to streamlining cancer diagnostics:

  • Creating additional diagnostic capacity using weekends, new diagnostics centres and independent sector diagnostics – For instance, the opening of new community diagnostic centres across England will provide elective diagnostics such as checks, scans and tests away from acute facilities and free up hospital capacity.
  • New population screening programmes – An example of this is the new lung cancer screening programme which aims at improving early diagnosis by running a low-dose CT scan of the lungs on high-risk people and inviting them for further tests if abnormalities are shown.
  • Implementing additional rapid diagnostic services for urgent patients – Like the national roll-out of fast-track testing, which from November 2022 allows every GP team to directly order CT scans, ultrasounds or brain MRIs for patients with concerning symptoms.

The examples provided above are just some of the latest initiatives aimed at cutting down waiting times for cancer patients across the NHS. In our experience, however, one approach has already shown huge potential for effectiveness: mutual aid between Trusts. In the next blog post, we’ll dive into the details of data-driven mutual aid and demonstrate the vast impact it can have on diagnostic and treatment efficiency and speeding up recovery.

[1] Along with patients referred by their GP with breast symptoms where cancer is not initially suspected; or referred by the National Screening Service with an abnormal screening result.
[2] The data used include both diagnosed and non-diagnosed patients. With more specific data this correlation is believed to be even stronger.

Why more patients than ever before are missing NHS cancer waiting times targets

December 2nd, 2022. Go to post.

In England, 40% of new cancer diagnoses come from an urgent referral from a GP [1]. NHS hospitals are required to start cancer treatment for everyone who’s been urgently referred within 62 days. These cancer waiting times standards help ensure people are rapidly diagnosed and treated – critical for long-term outcomes such as survival.

More patients than ever are now waiting more than 62 days for treatment. Of all completed pathways, the number of patients waiting longer than 62 days to receive treatment has almost doubled [2] from 6,242 in September 2019 to 11,910 in September 2022 – 39.5% of 62-day pathways, meaning that only 60.5% of patients are meeting the 62-day target. What factors are contributing to this?

Referrals are at record highs

After a drop in urgent referrals [3] in 2020 due to the Covid-19 pandemic, demand for cancer services is now at its highest since 2019 (a 38.0% increase from September 2019, corresponding to 249,994 urgent referrals in September 2022). There are several possible reasons behind this increase – from changes in referral patterns to the “missed” referrals during the pandemic that are now coming back to the system.

As shown in Figure 1 below, there seems to be a positive correlation between the increase in the number of 2 weeks wait referrals and the decrease in the percentage of patients meeting the 62-day target.

Figure 1

Diagnostics capacity is a bottleneck

The faster diagnosis standard, introduced as part of the long-term plan, ensures that people urgently referred from a GP [4] receive their diagnosis by day 28 of their pathway. From April 2021 to September 2022, the number of patients meeting this standard has dropped from 73% to 67%. This suggests that increased referrals are also constraining cancer diagnostics capacity. We can’t say for sure without patient-level data, but likely, many of the same patients who miss their diagnostic target (33%) also miss their treatment target.

Hospitals are working through their backlogs

Figure 2 illustrates that while capacity has been constrained throughout the pandemic, 5.1% more patients are now being treated every month compared to the 2019 average (27,332 vs 28,735). This suggests that Trusts are working hard to increase their capacity to meet the increase in demand.

Figure 2

There has been an increase in the number of extremely long waiters treated, with the percentage of people waiting longer than 104 days doubling from 5.5% in September 2019 to 12.9% in September 2022.

Trusts are focussing their increased capacity on their longest waiters – temporarily decreasing performance, but an indicator that Trusts are working to reduce their backlogs.

Managing increased referrals will continue to be a challenge for Trusts in the months to come. How will they meet this challenge?

In our next three blog posts in this series, we will explore potential solutions – including approaches to streamlining cancer diagnostics, the potential of mutual aid and strategies for identifying and reducing health inequalities.

[1] As of 2016, https://www.ncin.org.uk/publications/routes_to_diagnosis

[2] Grown by 90.8%

[3] Note that the two-week wait (2WW) appointments are a proxy for incoming referrals. Referrals may be higher given that only 73-78% of 2WW appointments have been within the standard from July-September 2022.

[4] Along with patients referred by their GP with breast symptoms where cancer is not initially suspected; or referred by the National Screening Service with an abnormal screening result.

Virginia is a Consultant at Edge Health. She has led multiple engagements supporting Trusts on the ground, managed large national data programmes and managed teams to develop sophisticated analysis to support quality improvement.