Inequalities in cancer 2-week-wait referrals: a cross-sectional study in English general practice

Practices with higher 2-week-wait (2WW) referral rates demonstrate higher survival for several cancers. Yet, there is little up-to-date evidence exploring factors influencing 2WW referral rates and whether health inequalities exist, particularly after COVID-19.

To establish which patient factors (for example, age, sex, ethnic group, deprivation) and practice factors (for example, remote consultations, frequency of seeing a preferred GP) independently predict 2WW referral rates.

A cross-sectional, observational study was performed using data from English general practices for 2021-2022.

Multivariable linear regression was used to identify the strongest, independent predictors of 2WW referral rates for all cancers (primary outcome) and for breast, lower-gastrointestinal, lung, and skin cancers separately (secondary outcome).

The analysis included 6307 practices. Practices with more females, patients aged ≥75 years, and patients with a greater burden of long-term conditions were associated with higher 2WW referrals for all cancers, as were practices in Northwest England, and those with higher scores for patients feeling involved in care decisions. Conversely, practices with a higher frequency of seeing a preferred GP were predictive of fewer all-cancer 2WW referrals. Practices with a higher proportion of currently smoking patients and Asian and Black ethnicity patients also predicted fewer all-cancer 2WW-referrals, and these associations were strongest for skin cancer, and for breast cancer (except for Black ethnicity). Higher socioeconomic deprivation predicted lower 2WW referrals for lung cancer only.

This study analyses factors influencing 2WW referral rates and highlights potential inequalities. This work identifies priority populations, including people who smoke, and Asian and Black ethnic group patients, who may benefit from interventions to increase primary care access. Shared decision making may be an underexplored resource for increasing all-cancer 2WW referral rates.