Diagnostic routes and time intervals for ovarian cancer in nine international jurisdictions; findings from the International Cancer Benchmarking Partnership (ICBP)
Usha Menon, David Weller, Alina Zalounina Falborg, Henry Jensen, John Butler, Andriana Barisic, Anne Kari Knudsen, Rebecca J. Bergin, David H. Brewster, Victoria Cairnduff, Evangelia Ourania Fourkala, Anna Gavin, Eva Grunfeld, Beth Harland, Jatinderpal Kalsi, Rebecca‐Jane Law, Yulan Lin, Donna Turner, Richard D Neal, Victoria White, Samantha Harrison, Irene Reguilon, Charlotte Lynch, Peter Vedsted, ICBP Module 4 Working Group, Andriana Barisic, Anna Gavin, Breann Hawryluk, Chantelle Anandan, Conan Donnelly, Henry Jensen, Jackie Boylan, Jacqueline Kelly, Kerry Moore, Maria Rejmyr Davis, Martin Malmberg, Mats Lambe, Oliver Bucher, Peter Vedsted, Rebecca J. Bergin, Sigrun Saur Almberg, Therese Kearney, Tindie Kalsi, Vicky Hammersley
Abstract
BACKGROUND: International Cancer Benchmarking Partnership Module 4 reports the first international comparison of ovarian cancer (OC) diagnosis routes and intervals (symptom onset to treatment start), which may inform previously reported variations in survival and stage. METHODS: Data were collated from 1110 newly diagnosed OC patients aged >40 surveyed between 2013 and 2015 across five countries (51-272 per jurisdiction), their primary-care physicians (PCPs) and cancer treatment specialists, supplement by treatment records or clinical databases. Diagnosis routes and time interval differences using quantile regression with reference to Denmark (largest survey response) were calculated. RESULTS: There were no significant jurisdictional differences in the proportion diagnosed with symptoms on the Goff Symptom Index (53%; P = 0.179) or National Institute for Health and Care Excellence NG12 guidelines (62%; P = 0.946). Though the main diagnosis route consistently involved primary-care presentation (63-86%; P = 0.068), onward urgent referral rates varied significantly (29-79%; P < 0.001). In most jurisdictions, diagnostic intervals were generally shorter and other intervals, in particular, treatment longer compared to Denmark. CONCLUSION: This study highlights key intervals in the diagnostic pathway where improvements could be made. It provides the opportunity to consider the systems and approaches across different jurisdictions that might allow for more timely ovarian cancer diagnosis and treatment.