Patients diagnosed with cancer after skipping appointment more likely to die within a year

12 September 2019
GP and patient

More support is needed for patients at risk of non-attendance

Cancer patients who miss an urgent referral appointment for their symptoms are 12% more likely to die within 12 months of diagnosis, a major new study has found.

The study, funded by Yorkshire Cancer Research, showed that male patients and those under 30 or over 85 years of age are more likely to skip their appointment, as are people who live in disadvantaged neighbourhoods and people who have been referred due to gastrointestinal problems.

The authors of the study say that more support is needed for patients at risk of non-attendance.

Led by researchers at the University of York and Hull York Medical School, the study looked at data from more than 100,000 patients who had been urgently referred by around 100 different GP practices in the North of England.

The majority of patients in the study (95%) attended their referral appointment, but a significant minority (5% or 5,673 people) did not.

While the study found that only one in 18 of the patients who skipped their appointment went on to be diagnosed with cancer - compared to one in 10 of those who did attend - the outlook for patients who missed their appointment and did have cancer was significantly worse.

The study revealed that 34.6% of non-attending patients with cancer had an advanced stage of the disease at diagnosis compared to 18.4% of attenders with cancer.

Having a more advanced stage of the disease is likely to be a reason why more non-attending patients with cancer died within a year of diagnosis (31.3% compared to 19.2% of attenders), the researchers say.

Dr Peter Knapp from the Department of Health Sciences at the University of York and Hull York Medical School, said: “Our study showed cancer diagnosis was less likely in non-attending patients but those who are diagnosed have worse outcomes than attending patients with cancer. This may be due to later presentation to their GP and more advanced disease at referral.

“Non-attendance at urgent referral appointments for suspected cancer involves a minority of patients, but happens in somewhat predictable groups. For example, we found that patients with suspected gastrointestinal cancer were among the least likely to attend – this may be due to concerns about unpleasant or embarrassing procedures.

“Our research suggests that more could be done to identify individuals at risk of non-attendance and offer extra support.”

The NHS’s ‘Two Week Wait’ policy aims to ensure that patients with suspected cancer are seen by a consultant within two weeks of an urgent GP referral.

While there is more awareness around the issues of ignored cancer screening invitations and the waste of resources incurred from missed GP appointments, the study is the first to focus on non-attendance of symptomatic patients referred due to suspected cancer.

Dr Stuart Griffiths, Director of Research and Services at Yorkshire Cancer Research, said: “Early diagnosis is vital in ensuring more people survive cancer, but there are many challenges facing both doctors and patients when it comes to accessing diagnosis and treatment swiftly. The charity is looking at ways it can work with the NHS and other research partners to determine how it can address factors leading to non-attendance at urgent referral appointments.”

Patient non-attendance at urgent referral appointments for suspected cancer and its links to cancer diagnosis and one year mortality: a cohort study of patients referred on the Two Week Wait pathway is published in Cancer Epidemiology.