Bowel cancer patients in Wales face diagnosis and treatment delays

An international collaborative study which compared the time it takes before bowel cancer patients are diagnosed and treated has revealed that patients in Wales face longer delays than their counterparts in other countries with similar healthcare systems.

The Welsh arm of the International Cancer Benchmarking Project (ICBP4), funded by Cancer Research Wales, showed that bowel cancer patients in Wales waited on average 168 days before they received either surgery, chemotherapy or radiotherapy, after first noticing symptoms.

This compared to only 105 days for patients in Norway, 83 days in parts of Australia, and 76 days in Denmark, the latter being the best performing country in the study. All nine countries in the study fared better than Wales, including other parts of the UK – with Scotland taking 52 days less to diagnose and treat bowel cancer.

Worryingly, the study found that around 10% of Welsh bowel cancer patients had to wait over a year before they started treatment. Annually, this equates to over 200 patients having to face these unacceptable delays.

The uniqueness of this study, which used a combination of patient questionnaires and medical records from both primary and secondary care, enabled the researchers to explore the routes to diagnosis and pinpoint exactly where in the patient pathway these delays occurred. One key finding was that bowel cancer patients in Wales took the longest to act on symptoms and visit their GP, which significantly influenced the overall delays.

The most common symptoms reported by Welsh bowel cancer patients was the presence of blood in stools, changes in bowel habits, closely followed by abdominal pain, weight loss and fatigue. Interestingly, the duration take n for GPs to refer patients for secondary care investigations such as colonoscopy after patients had sought help, was comparable to other countries.

Other significant delays were also observed in the secondary care setting, notably in the time taken to investigate for bowel cancer following GP referral, and to the start of treatment following confirmation of the disease. Diagnostic procedures in Wales took on average 52 days to complete, roughly three weeks longer than it took in Denmark and Victoria in Australia (a total of only 21 and 22 days respectively). Similar waits were also seen before the commencement of treatment after diagnosis.

The delays in secondary care almost certainly reflect the strains and pressures placed on existing diagnostic services in Wales when the study was undertaken. It has long been suspected that the limited resources currently available and an insufficient number of trained specialists for endoscopy and pathology – two vital components of the diagnostic process for bowel cancer – at a time of increased demand for these services, all adversely affect prompt cancer diagnosis. This current research provides the critical evidence to support these suspicions.

What this high-quality comparative study demonstrates is that Wales, like the rest of the UK, has some way to go in terms of improving timely diagnosis for bowel cancer. Increased equipment, workforce, and a smarter way of doing things are all needed if Wales is to close the gap on the best performing countries.

It is acknowledged that since the data for this study was collected, between 2013 and 2015, a series of welcomed initiatives to improve early diagnosis in Wales have been taken by Welsh Government. These include extra investment for endoscopy services in some Welsh regions, the opening of a national training centre for radiologists in Bridgend, and the commitment to a single cancer pathway.

Also, the two rapid diagnostic centres being trialled by the Wales Cancer Network in Neath Port Talbot Hospital and Cwm Taf, mirror the reforms that have seen Denmark significantly reduce the time taken to diagnose and treat cancer. Currently, cancer pathways in Wales are too long, convoluted, and overly complicated. It is hoped that a single cancer pathway will streamline and speed up the whole process, and prevent some patients from having to linger for long periods within the healthcare system before they receive treatment.

This current ICBP4 study for bowel cancer is the first of a series of papers to be published, with data for other cancer types soon to follow. All of which will help inform how parts of the single cancer pathway should be constructed for optimal performance.

However, further research is needed to better understand the reasons behind the marked variation in time delays between countries. These areas will include awareness of symptoms and health-seeking behaviour of patients, cancer knowledge and beliefs of GP, and structural differences in diagnostic infrastructure.

Bryn Roberts, Interim Charity Director of Cancer Research Wales, the funder of the study in Wales, said:

In recent years, early cancer diagnosis has been a priority area for investment by the charity. This international comparative study for bowel cancer provides an important baseline for Wales, against which we can measure the success of future improvements, as and when they occur. Through the avenue of research we will continue to work with all stakeholders so that we can deliver the best cancer care that the people of Wales thoroughly deserve.

Professor Richard Neal, who led the study in Wales, said:

These findings are really important because they allow us to pinpoint where, exactly, in the journey to a bowel cancer diagnosis, delays occur. This has already influenced initiatives to improve bowel cancer diagnosis by Welsh Government. The uniqueness of this study is that it used identical methods across a number of countries with similar health systems, so the findings from Wales can be directly compared to these other countries. We are grateful to Cancer Research Wales for funding the data collection in Wales.