More cancers are being diagnosed through urgent suspected cancer referral – exploring the data using a new visualisation tool

The National Cancer Registration and Analysis Service (NCRAS) has worked with partners to build a data visualisation tool on CancerData to show more information about cancer referrals and diagnosis.

The tool presents data on urgent suspected cancer (USC) referrals that result in a cancer diagnosis and data on individuals receiving cancer treatment following a USC referral.  

The tool looks at two metrics:

  • Conversion rate is the percentage of USC referrals which result in a diagnosis of cancer.
  • Detection rate is the percentage of cases recorded in the Cancer Waiting Times data as receiving a first treatment for cancer which resulted from a USC referral.

The tool allows users to look at and compare USC referral conversion and detection rates for different geographies and up to 14 cancer sites. Conversion and detection rates are presented for every financial year from 2009/10 onwards, and the trends over time from 2009/10 to 2018/19. Geographies include England, NHS regions, Cancer Alliances, Sustainability and Transformation Partnerships (STPs) and Clinical Commissioning Groups (CCGs).

Background

The NHS has several targets for the maximum length of time that individuals with suspected cancer or diagnosed cancer should wait to be seen or treated in England. These are known as the Cancer Waiting Times (CWT) targets. NHS England and NHS Improvement publish data on the number of patients seen or treated within the target waiting times.

Some of these targets support rapid access to specialist diagnostic and treatment services, for individuals with a USC referral. These referrals are made for patients with possible cancer symptoms based on referral guidance provided by the National Institute of Health and Care Excellence (NICE). The current NHS waiting time target for these referrals is often known as the ‘two-week wait’; within two weeks of being referred from their GP, individuals should be seen by a specialist in secondary care.

What does the tool tell us?

The percentage of all USC referrals which resulted in a cancer diagnosis (conversion rate) has decreased from 10.8% for 2009/10 to 7.1% for 2018/19 in England (Figure 1). This indicates that more of the USC referral patients seen by trusts do not have cancer. However, over the same period, there was a large increase in the number of USC referrals resulting in a 60% increase in the number of subsequent cancer diagnoses, from 97,760 in 2009/10 to 157,991 in 2018/19. This suggests the reduction in the conversion rate was due to a larger increase in the number of USC referrals. This increase is in-line with a 2015 change in referral guidance which recommended patients should be referred when their likelihood of cancer was lower than previously recommended.

Over the same period, the percentage of cases receiving treatment for cancer which resulted from a USC referral (detection rate) increased from 42.3% to 53.1%. An increase in detection rates indicates that trusts are detecting a higher proportion of new cancers from USC referrals. This increase is encouraging, with patients expected to benefit from quicker access to cancer services.

Figure 1: Trends in conversion and detection rates for all cancer sites from 2009/10 to 2018/19, England

This tool also presents geographical differences and differences between cancer sites. For example,

  • for all cancers combined in 2018/19, conversion rates for NHS regions ranged from 4.8% (London) to 8.3% (South West) and detection rates ranged from 49.4% (North West) to 55.6% (South West) (Figure 2).
  • in 2018/19, conversion rates ranged from 1% (suspected children’s cancer) to 21% (suspected haematological malignancies), and detection rates from 2% (brain or central nervous system (CNS) tumours) to 66% (urological cancers) (Figure 3).

Figure 2: USC referral conversion and detection rates for all cancer sites by NHS region, 2018/19

Figure 3: Cancer site-specific USC referral conversion and detection rates for England, 2018/19

What is the benefit of publishing this tool?

Although NCRAS regularly publish conversion and detection rates for all sites combined, this tool presents, for the first time, USC referral conversion and detection rates for a wider range of cancer sites and geographies.

This data provides an insight into referral activities and their contribution to diagnostic pathways. It will improve our understanding of cancer diagnostic pathways and inform resource planning. Understanding how trends have changed over time and how this differs between geographies and tumour sites is vital for service planning.

There is a demand for this data from stakeholders such as cancer charities, Cancer Alliances, Local Authorities, clinical colleagues and NHS England and NHS Improvement. The results will also be used for COVID-19 restoration and recovery plans.

How was the tool made? What data was used?

NCRAS has legal permission to collect patient-level data and use it for research to protect the health of the population. This permission is granted under Section 251 of the NHS Act 2006.

This analysis uses data from the National Cancer Waiting Times Monitoring dataset. This dataset is used to support the management and monitoring of cancer services in England, recording details of all urgent suspected cancer referrals and all patients receiving a first treatment for cancer.

Acknowledgements

This work has been produced in collaboration, involving analysts from: NCRAS, Public Health England (PHE); the Cancer Research UK – PHE partnership; the Transforming Cancer Services Team – PHE partnership, and the Cancer Alliances Data, Evidence and Analysis Service, NHS England and NHS Improvement – PHE partnership.

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is sourced from NHS Digital, NHS England and NHS improvement and collated, maintained and quality assured by NCRAS, which is part of Public Health England.

For further information please send an email to NCRASenquiries@phe.gov.uk.