Improving the diagnostic process for patients with bladder and kidney cancer: variations in pre-diagnostic clinical activities and events

Early diagnosis of cancer is crucial for better survival and patient experience. However, diagnosis can be difficult as benign non-cancerous conditions are common and cancer is quite rare. The use of tests forms a very important part in diagnosis, but what and when tests are done can vary for different patients with the same cancer. Furthermore, the use of tests has been shown to increase the time to be referred to a specialist and time to cancer diagnosis for some patients, likely due to the complexity of the testing process. The increased time to diagnosis may represent missed opportunities for an earlier diagnosis in some.

Using linked data from primary care, secondary care and the cancer registry in England, we aim to explore how symptoms and test use vary, and their link with the time to be referred to a specialist and time to diagnosis in patients with kidney and bladder cancer. We chose these two cancers as the number of patients diagnosed with kidney cancer and some types of bladder cancer is increasing, yet there is little evidence showing how these cancers are diagnosed. Also, women with kidney and bladder cancer are more likely to see their doctors several times before a referral, have a longer time to diagnosis and are less likely to be alive after being diagnosed with cancer than men. Therefore, finding out what predicts a longer time to diagnosis and these differences between men and women is very important.

Our study will highlight differences in diagnostic timeliness in patients with kidney and bladder cancer that may be related to use of tests. The findings will inform the development of ways to obtain a quicker diagnosis of these cancers in general, and specifically to reduce the male/female difference seen in patients with these cancers