1. Routes to Diagnosis of Cancer in London, 2006 - 2013 Katherine Henson, NCRAS, Presentation for London Public Health Knowledge and Intelligence Network meeting,18 th February 2016

2. Introduction Routes to diagnosis is a national work stream Categorisation of the route the patient follows to the point of diagnosis Work stream aim: examine demographic, organisational, service and personal reasons for delayed diagnosis Work stream includes a report of major resections: proportion of patients who have had surgery to remove a cancer London viewpoint: There are unique geographies in London – need to understand the variations Interest in patients who received a major resection for their tumour -- examine the variation in this key cancer treatment depending on their route to diagnosis 2Routes to Diagnosis of Cancer in London, 2006 - 2013

3. Data sources Uses routinely collected data sources to work backwards through patient pathways to examine the sequence of events that led to a cancer diagnosis: Hospital Episode Statistics Cancer Waiting Times Screening data Cancer registration data 3Routes to Diagnosis of Cancer in London, 2006 - 2013

4. Description of each route 4Routes to Diagnosis of Cancer in London, 2006 - 2013 RouteDescription Screen DetectedDetected via the breast, cervical or bowel screening programmes Two Week WaitUrgent GP referral with a suspicion of cancer GP Referral Routine and urgent referrals where the patient was not referred under the Two Week Wait referral route Other Outpatient An elective route starting with an outpatient appointment: either self-referral, consultant to consultant, other referral Inpatient Elective Where no earlier admission can be found prior to admission from a waiting list, booked or planned Emergency Presentation An emergency route via A&E, emergency GP referral, emergency transfer, emergency consultant outpatient referral, emergency admission or attendance Death Certificate Only No data available from Inpatient or Outpatient HES, CWT or Screening and with a death certificate only diagnosis flagged by the registry in the NCDR Unknown No data available from Inpatient or Outpatient HES, CWT or Screening within set time parameters or unknown referral

5. National publications 5Routes to Diagnosis of Cancer in London, 2006 - 2013

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10. London results 10Routes to Diagnosis of Cancer in London, 2006 - 2013

11. 11Routes to Diagnosis of Cancer in London, 2006 - 2013

12. 12Routes to Diagnosis of Cancer in London, 2006 - 2013

13. Big four cancers 13Routes to Diagnosis of Cancer in London, 2006 - 2013

14. 14Routes to Diagnosis of Cancer in London, 2006 - 2013

15. 15Routes to Diagnosis of Cancer in London, 2006 - 2013

16. 16Routes to Diagnosis of Cancer in London, 2006 - 2013 Complete roll-out in London

17. 17Routes to Diagnosis of Cancer in London, 2006 - 2013

18. 18Routes to Diagnosis of Cancer in London, 2006 - 2013 Symptomatic TWW introduced

19. 19Routes to Diagnosis of Cancer in London, 2006 - 2013

20. Variation by demographic factors 20Routes to Diagnosis of Cancer in London, 2006 - 2013

21. 21Routes to Diagnosis of Cancer in London, 2006 - 2013

22. 22Routes to Diagnosis of Cancer in London, 2006 - 2013

23. 23Routes to Diagnosis of Cancer in London, 2006 - 2013

24. Major resections 24Routes to Diagnosis of Cancer in London, 2006 - 2013

25. 25Routes to Diagnosis of Cancer in London, 2006 - 2013

26. 26Routes to Diagnosis of Cancer in London, 2006 - 2013

27. London emergency presentation 27Routes to Diagnosis of Cancer in London, 2006 - 2013

28. 28Routes to Diagnosis of Cancer in London, 2006 - 2013 * * *

29. 29Routes to Diagnosis of Cancer in London, 2006 - 2013

30. 30Routes to Diagnosis of Cancer in London, 2006 - 2013

31. Conclusion Overall trends are similar to the national picture Number of patients diagnosed through the emergency route has decreased to 23% in 2013, which is in-line with national figures Biliary tract cancer and cancer of unknown primary most commonly diagnosed through emergency (56%) followed by AML (54%) then brain cancer (53%) in 2013 Proportion diagnosed as TWW has increased: 30% diagnosed through TWW and 26% by GP referral in 2013, compared to 18% and 29%, respectively, in 2006 83% of those diagnosed through screening had a major resection, compared to 12% through emergency presentation (early vs late stage?) In 11 out of 16 cancer sites, TWW route had the greatest proportion of patients receiving a major resection 31Routes to Diagnosis of Cancer in London, 2006 - 2013

32. Acknowledgements Simon Lewry (LKIS for London) Sam Johnson (NCIN) Isabella Carneiro (NCIN) Anna Fry (NCIN) Thank you! Any questions? 32Routes to Diagnosis of Cancer in London, 2006 - 2013 Peer-reviewed paper in the British Journal of Cancer Technical document explaining how Routes are calculated National workbooks of updated data NCIN-CRUK Major resection report