Kidney cancer treatment delays rise

A new report jointly produced by Cancer Research UK and the National Disease Registration Service in July 2024 has shown that the percentage of cancer patients (all cancers) waiting for more than 104 days to begin treatment has risen by almost 300% since 2017.

Kidney Cancer UK has filtered the kidney cancer to give an in-depth look at the results, and what they tell us about waiting times for kidney cancer patients.

There are two important time periods to be considered in relation to waiting times:

104 days – NHS England policy is that all patients waiting more than 104 days to start treatment should have their cases reviewed to identify any avoidable delays.

62 days – NHS England‘s target time between the date the hospital receives an urgent suspected cancer referral and the start of treatment. Its current target is to see 85% of patients starting treatment within this time.

Delays in kidney cancer treatment

The report analyses the data for urological cancers in a separate sub-analysis. By focusing on the tumour-specific data, Kidney Cancer UK has been able to see a detailed picture of the period in the kidney cancer pathway between referral and the point at which the patient receives treatment.

Within the urological cancer cohort, the percentage of kidney cancer patients waiting over 104 days was 27.9%. This is considerably higher than the percentage across all cancers in which 12% of patients waited over 104 days for treatment. It shows that whilst there is concern about lengthening waiting times for all cancer patients, those with kidney cancer are waiting even longer.

Factors affecting waiting time in kidney cancer

Gender

Kidney cancer patients of female gender were less likely to wait over 104 days than those with male gender (Adjusted Odds Ratio 0.88).

Patient age

Age of the patient has an impact on kidney cancer waiting times. Patients in the older age groups were less likely to wait over 104 days compared with those aged 60-69. Also, younger patients were less likely to wait over 104 days.

Deprivation

Kidney cancer patients in the more deprived quintiles were more likely to wait over 104 days to start treatment.

Financial year

The data look at financial years 2017/2018, 2020/2021, 2021/2022 and April to September 2022/2023. The probability of a kidney cancer patient waiting more than 104 days for treatment increased by more than three times with each financial year (Adjusted Odds Ratio 3.41), comparing Q1 & Q2 2022/2023 with 2017/2018.

Tumour stage

People with higher stages of kidney cancer were less likely to be waiting over 104 days for treatment. This was different from the other urological cancers.

Comorbidities

There was no significant association between comorbidities and kidney cancer in terms of waiting over 104 days for treatment.

Other parts of the patient pathway

There was an increase in the time to treatment in most cancers, but it was more pronounced in kidney cancer. The longest interval on the kidney cancer patient pathway was that between referral and being informed of the diagnosis. This was true of all urological cancers.

Of the urological cancers, kidney cancer had the longest median time from decision to treat to treatment in Q1 & Q2 2022/2023. Also in the same financial year, the median interval from informed of diagnosis to decision to treat was 32 days for kidney cancer. Kidney Cancer UK believes these results strongly suggest that these parts of the kidney cancer patient pathway need to be improved.

Reasons for delays

‘Health care provider-initiated delay’ was the most common reason given for delays in referral to treatment for kidney cancer patients waiting over 104 or 62 days in Q1 & Q2 2022/2023. This is also the case for all cancers.

This could be due to many different reasons all relating to the hospital providing the services, including a shortage of hospital beds or low staff capacity. This was higher than medical reasons for delayed diagnosis or treatment (e.g. the patient being unwell) and delays initiated by the patient (e.g. cancelled appointments).

In the following figure, Kidney Cancer UK has summarised the proportion of health service delays resulting in waits of over 104 days for kidney cancer patients from referral to treatment to start of treatment.

Urgent suspected cancer referrals for kidney cancer

The probabilities of kidney cancer patients waiting more than 62 days between urgent suspected cancer referral and starting treatment were very similar to those for patients waiting over 104 days. However, in the case of waits over 62 days, there was no correlation with patient gender.

General remarks

It is worth noting that these data do not cover the time taken for the patient to be identified and referred for specialist investigation. In kidney cancer, this can add a significant delay. The latest Kidney Cancer UK Patient Survey (2023) indicates that 23% of kidney cancer patients are initially misdiagnosed before referral for specialist investigation. This most likely leads to a considerable additional delay that does not register on the data in this report.

From Kidney Cancer UK’s assessment of the data, the median time between decision to treat and treatment start in kidney cancer has gradually drifted up to the 31-day target and in Q1 & Q2 2022/2023 was 31.5 days.

In common with all cancers, the longest period in the kidney cancer patient pathway is from referral to being informed of diagnosis. Kidney Cancer UK’s work in kidney cancer service quality tells us there are many factors that contribute to this, not least the level of capacity in diagnostic imaging.

Those patients who are more deprived, male, aged 60-69 and with lower tumour stages (1 or 2) are more likely to wait more than 104 days for treatment. On the one hand, our patient survey shows that 45% of kidney cancer patients are not diagnosed until their tumour has reached stage 3 or 4.1 On the other hand, treating kidney cancer patients (including active surveillance) when their tumours are at stage 1 or 2 can be more effective than doing so when the tumour has reached stage 3 or 4. Kidney Cancer UK believes early identification and diagnosis is crucial.

In common with other cancers, the main reasons for delay come from problems encountered by the health care providers. We believe though challenging, these difficulties can often be addressed; for example, by looking at new ways of providing services. Kidney Cancer UK is closely involved in the new National Kidney Cancer Audit.Once it has had time to settle in, this will help Cancer Alliances and providers improve their services. Similarly, we were involved in the development of the Getting It Right First Time (GIRFT) guide ‘Urology: Towards better care for patients with kidney cancer’ which describes the key features of a good kidney cancer service and lists the quality actions teams can take to bridge any gaps they identify.

In addition, Kidney Cancer UK successfully campaigned for the development of the Clinical Guideline and Quality Standard for kidney cancer, being developed by the National Institute for Health and Care Excellence. This will act as an invaluable guide, when it is published.

The message from the Kidney Cancer UK analysis of the data clearly states that there has never been a more important time to review kidney cancer services in the NHS.

References
Unless otherwise stated, all data and figures quoted in this article are from ‘Which cancer patients experience long waits to treatment, and why? – Analysis of patients waiting over 104 days from urgent suspected cancer referral to first cancer treatment in England, for 2017/2018, 2020/2021, 2021/2022 and 2022/2023’ Published by Cancer Research UK in July 2024. Authors: Lorna Wills, Scarlett Cartwright-Hughes, Rosie Hinchliffe, Shane Johnson, Sophia Lowes, Fahmina Fardus-Reid, Lucy Ironmonger, Jon Shelton, Lyndsy Ambler, Sam Harrison, Sean McPhail, Lizz Paley, Carolynn Gildea.

The full report and urological cancers sub-analysis can be accessed on the Cancer Research UK website
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[1] Annual Patient Survey 2023. Kidney Cancer UK. https://www.kcuk.org.uk/wp-content/uploads/2024/02/KCUK_PATIENT_SURVEY_2023_FINAL_digital.pdf
[2] Urology: Towards Better Care for Patients with Kidney Cancer. Getting It Right First Time. NHS England. 2023. https://gettingitrightfirsttime.co.uk/girft-guide-supports-better-care-for-people-with-kidney-cancer/