NHS Staffing Shortages Behind Delays in Cancer Diagnoses for Patients in UK

A study published in Cancer Epidemiology this week found that a quarter of patients with cancer in the United Kingdom experience avoidable delays when it comes to diagnosing the disease, largely due to staffing shortages within the National Health Service.

Researchers used data from the English National Cancer Diagnosis Audit to assess which of the 17,042 patients diagnosed with cancer in 2014 had their diagnoses unnecessarily delayed, relying on assessments by primary care physicians. Ultimately 14,259 patients were included in the study and physicians reported nearly 3400 patients had their diagnoses avoidably delayed (roughly 24%).

Around half of those with avoidable delayed diagnoses experienced a median diagnostic interval of 92 days. This is nearly a 2-month increase compared with the median of 30 days experienced by the other half of the cohort.

The national cancer registry notes that around 14,300 people are diagnosed with cancer in England every year. Researchers concluded that improvement initiatives are necessary to eradicate these diagnosis delays to prevent future adverse effects on patients.

When a patient’s diagnosis is delayed or missed, it can affect the treatment options available, severity of prognosis, and the patient’s experience living with the disease. For instance, in the United States, missed diagnostic opportunities are estimated to affect 1 in 20 adults receiving outpatient care.

To conduct the study, researchers asked general practitioners (GPs) to identify the setting of the delay, whether in primary, pre-consultation, or secondary care, along with key attributable factors.

Researchers state, “Avoidable delays were mostly attributed to the test request/performance phase (25%).” Longer diagnostic intervals occurred when the delay of care was attributable to primary care (98 days) or secondary/tertiary care (110 days) and not in pre-consultation (27 days).

Some key factors identified were type of cancer diagnosed, the presence of comorbidities, and a patient’s age and socioeconomic status.

“In patients living in areas of higher deprivation, there were higher odds of a delay in the help-seeking phase,” the authors stated. Deprivation factors included income, employment, educational skills and training, and environment.

Patients with stomach cancer accounted for 34.4% of those with avoidable delays, while patients with breast cancer accounted for just 10.3%. Patients over the age of 85 also faced increased odds of an avoidable delay.

In addition, the authors state, “Multimorbidity was associated with greater odds of avoidable delay.” This is an expected result, as oftentimes symptoms might be assumed to stem from the patient’s existing conditions.

“Trying to find cancer in people with a range of symptoms and other conditions is very complicated. And while NHS doctors and nurses are doing everything they can to see patients quickly, the NHS is experiencing a staffing crisis. There simply aren’t enough people in the NHS to read scans or report tests swiftly,” Sara Hiom, the director of early diagnosis at Cancer Research UK, said in a statement.

A major contributing factor to the findings is the shortage of medical staff necessary to expedite the diagnosis process.

She continued, “Waiting for a possible cancer diagnosis is an extremely anxious time, so no one should have to wait longer than is absolutely necessary… Without the right staff, including GPs, it will be impossible to diagnose and treat patients more swiftly and effectively.”

The authors of the study hope the findings will assist in formulating a framework for increasing earlier investigations and improving referral pathways, streamlining patients’ future diagnoses.

Since the study included nearly 3400 patients, it is “considerably larger than any comparable studies of diagnostic error to date,” according to the authors. They also state the study population is representative enough to have results generalized to the wider population.

Reference

Swann R, Lyratzopoulos G, Rubin G, Pickworth E, McPhil S. The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients [published online December 3, 2019]. Cancer Epidemiol. doi: 10.1016/j.canep.2019.101617.