Time to diagnosis of cancer in children and young adults in secondary care services

Purpose: A prolonged time to diagnosis (TTD) for cancer patients has been highlighted as a factor potentially contributing to worse outcomes. The majority of early diagnosis research in childhood and young adult (CYA) cancer has focused on primary care. This population-based study aimed to investigate TTD in secondary care services for CYAs diagnosed with cancer and its effect on survival in Yorkshire, UK. Method: 1098 cases of cancer aged between 0-24 years were identified from the Yorkshire Specialist Registry of Cancer in Children and Young People over a 6 year period. ICD-10 codes contained within the in-patient HES episodes were reviewed against accepted UK CYA cancer awareness campaigns in order to identify alert signs and symptoms preceding the date of definitive diagnosis. The cohort was analysed in terms of the time spent in hospital care, number of alert and non-alert code containing events and 1 and 3-year survival, the latter modelled using Cox regression. Results: 457 (41.6%) cases had no identifiable alert code containing episodes preceding their date of diagnosis. In two thirds of the remaining cases (437/641) the alert codes only occurred within the month preceding diagnosis. Cases with alert codes present within the month prior to diagnosis had a significantly poorer survival compared to patients with no alert code containing episodes (hazard ratio=1.67, p=0.003). For cases with a more prolonged TTD, there was a significantly poorer survival for 15-24 year olds (hazard ratio = 2.48, p=0.001) but not for 0-14 year olds (hazard ratio=0.98, p=0.964). Conclusions: In Yorkshire, secondary care services appear to be organised effectively to deal with timely diagnosis of CYA cancers. This research supports the current focus of early diagnosis research at primary care for childhood cancer but indicates the need for further investigation of TTD in secondary care particularly in the TYA population.