Speeding up cancer diagnosis: how to break the 28-day barrier

Standards introduced in October 2021 mandate that at least 75% of patients urgently referred by a GP[1] for suspected cancer should receive a diagnosis (or be cleared) within 28 days. In September 2022, however, 33% of them – 78,000 a month – did not receive a timely diagnosis. This reduces their chances of survival considerably by preventing prompt treatment.

As shown in Figure 1, from April 2021 to September 2022, the number of patients meeting the 28-day target has dropped from 73% to 67%, and the 75% target has yet to be met. This is likely due to the large increase in the number of referrals registered during the past months which is constraining diagnostics capacity (as discussed in our previous post).

This varies greatly by suspected cancer. The 28-day rate for breast and children’s cancer in September 2022 was in fact close to 90%, while for tumour sites such as gynaecology, skin, lower gastrointestinal and urology (including prostate) it was as low as 50%.

For urological malignancies, the failure to meet the 28-day diagnostic target has a significant impact on the 62-day treatment target. As shown in Figure 2, the longer the delay in obtaining a diagnosis, the more likely patients are to miss the 62-day treatment benchmark. This highlights the crucial importance of timely diagnosis in ensuring prompt and effective cancer treatment.
Furthermore, as the number of diagnostic tests administered increases, so does the proportion of patients who meet the 28-day diagnostic target. This correlation suggests that delays and capacity limitations in diagnostic testing are playing a key role in the decline of cancer care outcomes nationwide[2].

This is not going unnoticed, with trusts racing to implement a number of solutions to reduce pressure on hospitals and provide quicker access for patients. There are three broad groups of approaches to streamlining cancer diagnostics:

• Creating additional diagnostic capacity using weekends, new diagnostics centres and independent sector diagnostics – For instance, the opening of new community diagnostic centres across England will provide elective diagnostics such as checks, scans and tests away from acute facilities and free up hospital capacity.
• New population screening programmes – An example of this is the new lung cancer screening programme which aims at improving early diagnosis by running a low-dose CT scan of the lungs on high-risk people and inviting them for further tests if abnormalities are shown.
• Implementing additional rapid diagnostic services for urgent patients – Like the national roll-out of fast-track testing, which from November 2022 allows every GP team to directly order CT scans, ultrasounds or brain MRIs for patients with concerning symptoms.

The examples provided above are just some of the latest initiatives aimed at cutting down waiting times for cancer patients across the NHS. In our experience, however, one approach has already shown huge potential for effectiveness: mutual aid between Trusts. In the next blog post, we’ll dive into the details of data-driven mutual aid and demonstrate the vast impact it can have on diagnostic and treatment efficiency and speeding up recovery.

[1] Along with patients referred by their GP with breast symptoms where cancer is not initially suspected; or referred by the National Screening Service with an abnormal screening result.
[2] The data used include both diagnosed and non-diagnosed patients. With more specific data this correlation is believed to be even stronger.