Is current GP referral practice for cancer in Scotland optimal? A detailed exploration of cancer referral pathways using primary care records and a cancer care pathway database

Background: Scotland has poorer cancer survival rates com-pared with others parts of the UK and other developed coun-tries, due in part to later stage diagnosis. Scottish Referral Guidelines for Suspected Cancer (2007) seek to enable GPs to diagnose cancers as soon as possible, as does the ‘urgent suspected cancer’ (USC) electronic referral system between pri-mary and secondary care. The Scottish Government has also launched a social marketing campaign, ‘Detect Cancer Early’(DCE) for lung, breast, and colorectal cancer, to promote earlier diagnosis. The dual objectives of this project have been to discover how effectively USC guidelines are currently being used, and to explore the impact of the DCE campaign Research questions: 1. Does current GP use of USC referrals support the diagnosis of earlier stage cancer? 2. What effect has the DCE campaign had on how patients present with cancer?
Methods: Detailed mapping of the diagnostic pathway (from presentation to diagnosis) followed by 2105 cancer patients in North East Scotland through a primary care medical records review and linkage of collected data to an electronic clinical database.
Results – are a work in progress; a preliminary analysis will be available before the conference: Full analysis will include route to diagnosis, time to diagnosis, and stage at diagnosis using the internationally defined time points in the Aarhus Statement; detection and conversion rates before and after the DCE campaign; calculation of QCancer and CAPER predicted risks at time of referral.
Discussion: This project will enable assessment of whether the Scottish USC referral system actually supports GPs in the diagnosis of early stage cancer, and provide insight into how effective the DCE campaign has been at prompting earlier presentation. As part of an international collaboration investigating the link between late presentation of cancer and survival,these data will be suitable for international comparisons and pooled analyses