What is the relationship between staging and diagnostic interval in patients aged 40 years and over diagnosed with common cancers between 2000 and 2009?

The problem

Shorter time from first symptom presentation to diagnosis is generally assumed to lead to better staging and better survival. However the association between diagnostic interval (DI)and staging is unknown. Do shorter DIs lead to better staging?

The approach

Patients in the CPRD with one of 11 common primary cancers diagnosed between 2000 and 2009 were included. Patients were linked to cancer registry data for staging. The DI was calculated from first symptom to diagnosis.

Findings

In total, 2547 patients (female 1550, 60.8%) across 11 sites with staging (early /late) had a cancer diagnosis. Of these 1377 were early stage, 801 (58.2.9%) diagnosed before 2005 and 576 (41.8%) in 2005 or later. Women had greater odds than men of having an early stage cancer p<0.001.Shorter median DIs were recorded in women (64 days, 95% CI 57 to 69 days) than men (101 days, 95% CI 89 to 113 days) p<0.001. However, this gender difference was only seen in early stage cancers p<0.001. Once breast cancer was excluded from the model little gender difference in DIs was seen; men (101 days, 95% CI 89 to 113 days), women (96 days, 95% CI 88 to 103 days). Shorter DIs were associated with better staging. However cancers diagnosed after 2005 had a longer interval from presentation of the first symptom to diagnosis (p=0.036) and there was no difference in staging.

Consequences

Shorter intervals from presentation of first symptom to diagnosis are associated with better staging. No stage shift was reported following the revision of NICE guidance. In addition DIs were longer across all cancers in those diagnosed after 2005 and revision of NICE guidance.Further results will be available by the time of the conference.

Credits

• Sal Stapley
• Willie Hamilton