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Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015-2016
Yngvar Nilssen1, Odd Terje Brustugun2, Morten Tandberg Eriksen3,4
1Department of Registration, Cancer Registry of Norway, Oslo, Norway. yngvar.nilssen@kreftregisteret.no.
Background:
Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion.
Methods:
All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015-2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity.
Results:
From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70-2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00-1.54) and lung (OR = 1.52, 95%CI: 1.16-1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients.
Conclusions:
The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.
Insights
Cancer patient pathways (CPPs) in Norway exceeded the 70% inclusion target within a year. However, factors like prostate cancer diagnosis, older age, and low income were linked to lower CPP inclusion rates.
Area of Science:
- Oncology
- Health Services Research
- Public Health
Background:
- Cancer Patient Pathways (CPPs) were introduced in Norway in 2015 to standardize cancer care.
- Key objectives included reducing waiting times, minimizing regional disparities, and enhancing care predictability.
Purpose of the Study:
- To evaluate if the national target of 70% CPP inclusion was achieved.
- To identify demographic and clinical factors associated with CPP inclusion or exclusion.
Main Methods:
- Data from the Norwegian Patient Registry and Statistics Norway were used.
- A cohort of 30,747 patients diagnosed with colorectal, lung, breast, or prostate cancer between 2015-2016 was analyzed.
- Multivariable logistic regression identified factors associated with non-inclusion in CPPs.
Main Results:
- Overall CPP inclusion reached 79.5%, surpassing the 70% target.
- Significant improvements in inclusion rates were observed across all studied cancer types.
- Older age, prostate cancer diagnosis, higher comorbidity, and lower income were associated with increased odds of non-inclusion.
Conclusions:
- The national target for CPP inclusion was met within the first year of implementation.
- Despite meeting the overall target, disparities in access exist.
- Prostate cancer patients, older individuals, those with comorbidities, and lower-income patients faced higher risks of exclusion from CPPs.
