An Investigation Of Routes To Cancer Diagnosis In Ten International Jurisdictions Survey Development And Implementation Of ICBPM4

David WELLER, University of Edinburgh , United Kingdom
MENON U. 2 , VEDSTED P. 3 , ZALOUNINA FALBORG A. 3 , JENSEN H. 3 , WORKING GROUP I. 4

1 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
2 Institute for Women's Health, University College London, London, United Kingdom
3 Research Unit for General Practice, Aarhus University, Aarhus, Denmark
4 ICBP Module 4 Working Group, Cancer Research UK, London, United Kingdom

Purpose: International differences in cancer survival, reported previously by the International Cancer Benchmarking Partnership (ICBP), may be linked to differences in time intervals from first symptom(s) until diagnosis and start of treatment, and routes to diagnosis of cancer patients. Module 4 of the ICBP will provide the first robust international comparison of these parameters. We present the study design and recruitment processes, and report reliability testing and response rates of the developed questionnaires.  
Methods: A prospective study involving questionnaires from newly diagnosed patients and their primary care physicians (PCPs) and cancer treatment specialists (CTSs) was undertaken. Patients were identified through cancer registries data in each jurisdiction. The recruitment target was 200 breast, lung, colorectal and ovarian patients, diagnosed through a symptomatic route in each of ten participating jurisdictions in 6 countries. Data on screen-detected patients was also collected. Screened patients were also recruited as it was not possible to identify these patients through cancer registry data in all jurisdictions. Data and audit information from treatment records or databases supplemented the questionnaire data. Hierarchal ‘data rules’ were applied to combine and reconcile conflicting information. 
Results: Analysis of colorectal and breast cancer data showed that intervals for screened and symptomatic patients can be compared between jurisdictions. Reliability testing broadly showed good agreement for items within the patient questionnaire, and response rates to the questionnaires were comparable with similarly published questionnaires in some jurisdictions.
Conclusion: An international questionnaire-based survey of patients, PCPs and CTSs was undertaken in ten jurisdictions. This is the first attempt to describe and compare between countries the patient journey from symptom onset to a cancer diagnosis and treatment. ICBPM4 could provide unique insights into cancer survival differences, and identify areas where improvements may be made in health systems.
Funding source: Provided by various sources from each participating jurisdiction.