Initiatives to improve time to diagnosis and cancer

Increasing  patient´s symptoms  awareness, a better clinical performance based on delayed case analysis and system changes, could help to achieve a timely and improved  diagnostic process in cancer.

Actions to reach this goal have been implemented to different levels, the first one trying to increase the awareness of the population about cancer with initiatives like NAEDI (The National Awareness and Early Diagnosis Initiative) in England [114] or CAM (Cancer Awareness Measure) what is a tool to measure public awareness of the signs and symptoms of cancer and the barriers involved to seek medical help [115]. Other actions have the goal to speed the referral routes for patients who have a high index of suspicion like the Two-Weeks Wait Referral System in England [116].

A second group of initiatives are aimed to improve the diagnosis of symptomatic patients reducing  the “missed opportunities” scenario with actions summarized by Lyratzopoulos et al. [117] such as re-engineering medical consultation and history taking and examination, reducing cognitive or system barriers in clinical assessment and improving diagnostic test performance and interpretation.

A third package of initiatives are directed to facilitate the performance of primary care doctors, with two actions, the CAPER score and QCancer. The CAPER score [118] is a scoring system that has been derived to  identify those most at risk of cancer, when they only have a low-risk symptom and it encourages GPs to identify other symptoms that could help to increase the probability of a cancer diagnosis. The QCancer initiative, also implemented  in the UK, defines QCancer risks models of multiple cancers according to baseline risks factors, patterns of symptoms and specific clinical conditions, with models developed separately for women [119] and men [120], with a direct application as an electronic tool to help GPs in the diagnostic process. Physician education and training strategies complete the group of actions aiming to improve the diagnostic skills of GPs and to reduce delay in cancer diagnosis [121].

[114] Richards MA. The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. British Journal of Cancer 2009; 101: S1-4

[115] Robb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Waller J, et al. Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer 2009; 101(Suppl 2): S18-S23


[116] UK Department of Health, Health Service Circular. HSC2000/013 Referral guidelines for suspected cancer (online), 4004320 (2000)



[117] Lyratzopoulos G, Vedsted P, Singh H. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation, BJC 2015; DOI:10.1038/bjc.2015.47

[118] Hamilton W. The CAPER studies: five case-control studies aimed at identifying and quantifying the risk of cancer in symptomatic primary care patients. Br J Cancer 2009; 101: S80-S86

[119] Hippisley-Cox J, Coupland C. Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; DOI:10.3399/bjgp13X660733

[120] Hippisley-Cox J, Coupland C. Symptoms and risk factors to identify men with suspected cancer in primary care: derivation and validation of an algorithm.Br J Gen Pract 2013; DOI: 10.3399/bjgp13X660724

[121] Mansell G, Shapley M, Jordan JL, Jordan K. Interventions to reduce primary care delay in cancer referral: a systematic review. British Journal of General Practice 2011; DOI: 10.3399/bjgp11X613160