Table 1.
Distribution of patients by referral pathway, stage of cancer, and 1-year, 3-year, and 5-year net survival in the pre-pandemic period and by each pandemic scenario
| Patients | Stage III–IV* |
Net survival |
||||||
|---|---|---|---|---|---|---|---|---|
| 1 year | 3 years | 5 years | ||||||
| Breast cancer | ||||||||
| Pre-pandemic period | ||||||||
| Emergency presentation | 930 (2·9%) | 245/356 (68·8%) | 56·3% (53·9–58·6) | 39·0% (37·0–41·0) | 33·4% (31·8–35·1) | |||
| GP referral | 5136 (15·8%) | 566/2836 (20·0%) | 96·3% (96·2–96·3) | 90·0% (89·9–90·1) | 86·2% (86·2–86·3) | |||
| Other routine† | 887 (2·7%) | 93/418 (22·2%) | 94·0% (93·8–94·2) | 85·8% (85·5–86·1) | 81·3% (81·0–81·7) | |||
| Screening | 10 795 (33·1%) | 406/6789 (6·0%) | 100·0% (100–100) | 99·6% (99·6–99·6) | 98·8% (98·8–98·8) | |||
| 2-week wait | 14 835 (45·5%) | 1821/8934 (20·4%) | 97·9% (97·9–97·9) | 91·3% (91·3–91·4) | 86·3% (86·2–86·3) | |||
| Overall | 32 583 (100%) | .. | 97·0% (97·0–97·1) | 92·2% (92·2–92·3) | 88·8% (88·7–88·8) | |||
| Pandemic period | ||||||||
| Scenario A | .. | .. | 96·0% (95·9–96·1) | 89·0% (88·9–89·1) | 83·9% (83·9–84·0) | |||
| Emergency presentation | 1149 (4·7%) | .. | .. | .. | .. | |||
| 2-week wait | 23 357 (95·3%) | .. | .. | .. | .. | |||
| Scenario B | .. | .. | 95·9% (95·9–96·0) | 88·8% (88·7–88·9) | 83·6% (83·6–83·7) | |||
| Emergency presentation | 1225 (5·0%) | .. | .. | .. | .. | |||
| 2-week wait | 23 286 (95·0%) | .. | .. | .. | .. | |||
| Scenario C | .. | .. | 95·9% (95·8–96·0) | 88·7% (88·6–88·8) | 83·6% (83·5–83·6) | |||
| Emergency presentation | 1249 (5·1%) | .. | .. | .. | .. | |||
| 2-week wait | 23 240 (94·9%) | .. | .. | .. | .. | |||
| Colorectal cancer‡ | ||||||||
| Pre-pandemic period | ||||||||
| Emergency presentation | .. | .. | 54·8% (54·6–55·1) | 40·3% (40·1–40·4) | 35·1% (34·9–35·2) | |||
| Colon | 4143 (26·1%) | 1753/2263 (77·5%) | .. | .. | .. | |||
| Rectum | 1040 (11·4%) | 459/584 (78·6%) | .. | .. | .. | |||
| GP referral | .. | .. | 83·5% (83·4–83·5) | 70·6% (70·5–70·7) | 64·4% (64·3–64·4) | |||
| Colon | 3769 (23·8%) | 1262/2082 (60·6%) | .. | .. | .. | |||
| Rectum | 2538 (27·9%) | 903/1531 (59·0%) | .. | .. | .. | |||
| Other routine† | .. | .. | 83·7% (83·6–83·8) | 71·3% (71·2–71·4) | 65·4% (65·3–65·5) | |||
| Colon | 2063 (13·0%) | 666/1112 (59·9%) | .. | .. | .. | |||
| Rectum | 1001 (11·0%) | 365/587 (62·2%) | .. | .. | .. | |||
| Screening | .. | .. | 97·5% (97·5–97·5) | 92·9% (92·9–93·0) | 89·6% (89·6–89·7) | |||
| Colon | 1922 (12·1%) | 431/985 (43·8%) | .. | .. | .. | |||
| Rectum | 1102 (12·1%) | 307/677 (45·3%) | .. | .. | .. | |||
| 2-week wait | .. | .. | 85·0% (85·0–85·1) | 71·2% (71·2–71·3) | 64·2% (64·1–64·2) | |||
| Colon | 3970 (25·0%) | 1493/2444 (61·1%) | .. | .. | .. | |||
| Rectum | 3427 (37·6%) | 1449/2344 (61·8%) | .. | .. | .. | |||
| Overall | .. | .. | 79·7% (79·7–79·8) | 67·3% (67·2–67·3) | 61·4% (61·4–61·5) | |||
| Colon | 15 867 (100%) | .. | .. | .. | .. | |||
| Rectum | 9108 (100%) | .. | .. | .. | .. | |||
| Pandemic period | .. | .. | .. | .. | .. | |||
| Scenario A | .. | .. | 76·0% (75·9–76·0) | 61·9% (61·8–61·9) | 55·3% (55·3–55·3) | |||
| Emergency presentation | ||||||||
| Colon | 6166 (38·9%) | .. | .. | .. | .. | |||
| Rectum | 1570 (17·2%) | .. | .. | .. | .. | |||
| 2-week wait | ||||||||
| Colon | 9700 (61·1%) | .. | .. | .. | .. | |||
| Rectum | 7538 (82·8%) | .. | .. | .. | .. | |||
| Scenario B | ||||||||
| Emergency presentation | .. | .. | 75·7% (75·6–75·7) | 61·6% (61·6–61·7) | 55·1% (55·1–55·2) | |||
| Colon | 6384 (40·2%) | .. | .. | .. | .. | |||
| Rectum | 1654 (18·2%) | .. | .. | .. | .. | |||
| 2-week wait | ||||||||
| Colon | 9482 (59·8%) | .. | .. | .. | .. | |||
| Rectum | 7454 (81·8%) | .. | .. | .. | .. | |||
| Scenario C | ||||||||
| Emergency presentation | .. | .. | 75·5% (75·5–75·6) | 61·5% (61·4–61·5) | 55·0% (55·0–55·0) | |||
| Colon | 6456 (40·7%) | .. | .. | .. | .. | |||
| Rectum | 1678 (18·4%) | .. | .. | .. | .. | |||
| 2-week wait | ||||||||
| Colon | 9410 (59·3%) | .. | .. | .. | .. | |||
| Rectum | 7430 (81·6%) | .. | .. | .. | .. | |||
| Lung cancer | ||||||||
| Pre-pandemic period | ||||||||
| Emergency presentation | 9636 (32·9%) | 7674/8690 (88·3%) | 15·9% (15·9–15·9) | 6·6% (6·6–6·6) | 4·6% (4·6–4·6) | |||
| GP referral | 6549 (22·3%) | 4158/6108 (68·1%) | 46·4% (46·4–46·4) | 26·1% (26·1–26·1) | 19·6% (19·6–19·6) | |||
| Other routine† | 4003 (13·7%) | 2483/3732 (66·5%) | 50·3% (50·3–50·4) | 29·1% (29·1–29·1) | 22·0% (22·0–22·0) | |||
| 2-week wait | 9117 (31·1%) | 6806/8917 (76·3%) | 48·7% (48·7–48·7) | 21·9% (21·9–21·9) | 13·6% (13·6–13·6) | |||
| Overall | 29 305 (100%) | .. | 37·6% (37·6–37·6) | 18·8% (18·8–18·8) | 13·1% (13·1–13·1) | |||
| Pandemic period | ||||||||
| Scenario A | .. | .. | 34·1% (34·0–34·1) | 15·1% (15·1–15·1) | 9·6% (9·6–9·6) | |||
| Emergency presentation | 12 802 (43·7%) | .. | .. | .. | .. | |||
| 2-week wait | 16 503 (56·3%) | .. | .. | .. | .. | |||
| Scenario B | .. | .. | 33·3% (33·3–33·3) | 14·7% (14·7–14·7) | 9·4% (9·4–9·4) | |||
| Emergency presentation | 13 715 (46·8%) | .. | .. | .. | .. | |||
| 2-week wait | 15 590 (53·2%) | .. | .. | .. | .. | |||
| Scenario C | .. | .. | 33·1% (33·1–33·1) | 14·6% (14·6–14·6) | 9·3% (9·3–9·3) | |||
| Emergency presentation | 13 538 (46·2%) | .. | .. | .. | .. | |||
| 2-week wait | 15 767 (53·8%) | .. | .. | .. | .. | |||
| Oesophageal cancer | ||||||||
| Pre-pandemic period | ||||||||
| Emergency presentation | 1228 (18·2%) | 258/283 (91·2%) | 20·7% (20·3–21·1) | 9·5% (9·4–9·7) | 7·9% (7·8–8·1) | |||
| GP referral | 1410 (20·9%) | 215/300 (71·7%) | 54·8% (54·6–55·0) | 27·3% (27·2–27·4) | 21·2% (21·0–21·3) | |||
| Other routine† | 1303 (19·3%) | 196/268 (73·1%) | 55·7% (55·6–55·9) | 29·7% (29·6–29·9) | 23·9% (23·7–24·0) | |||
| 2-week wait | 2803 (41·6%) | 629/755 (83·3%) | 48·2% (48·1–48·3) | 19·1% (19·0–19·2) | 13·4% (13·3–13·5) | |||
| Overall | 6744 (100%) | .. | 46·0% (45·9–46·1) | 21·1% (21·1–21·2) | 16·1% (16·0–16·1) | |||
| Pandemic period | ||||||||
| Scenario A | .. | .. | 41·3% (41·2–41·4) | 16·7% (16·7–16·8) | 12·0% (12·0–12·1) | |||
| Emergency presentation | 1690 (25·1%) | .. | .. | .. | .. | |||
| 2-week wait | 5054 (74·9%) | .. | .. | .. | .. | |||
| Scenario B | .. | .. | 39·9% (39·7–40·0) | 15·8% (15·7–15·8) | 11·3% (11·3–11·4) | |||
| Emergency presentation | 1783 (26·4%) | .. | .. | .. | .. | |||
| 2-week wait | 4961 (73·6%) | .. | .. | .. | .. | |||
| Scenario C | .. | .. | 39·7% (39·6–39·8) | 15·7% (15·7–15·8) | 11·3% (11·2–11·3) | |||
| Emergency presentation | 1812 (26·9%) | .. | .. | .. | .. | |||
| 2-week wait | 4932 (73·1%) | .. | .. | .. | .. | |||
Data are n (%), n/N (%), or net survival with 95% CI in parentheses. For breast cancer, in addition to patients on routine pathways, only 25% (n=2700) of patients diagnosed through screening (ie, the proportion of patients with T3, T4, node positive, or metastatic disease) were reallocated to 2-week wait and emergency presentation in the pandemic scenarios.
*
The proportion of patients diagnosed with stage III or IV disease is based on patients with available staging information in the cancer registry dataset and has been reported to show the stage variation according to diagnostic referral route; information on cancer stage is not used in the modelling of net survival.
†
Includes referrals within secondary care.
‡
Net survival for colorectal cancer is for both colon and rectum tumour type combined. However, allocation of patients to 2-week wait and emergency presentation diagnostic routes was done separately for each tumour type.