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Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey
  1. Peter W Rose1,
  2. Greg Rubin2,
  3. Rafael Perera-Salazar1,
  4. Sigrun Saur Almberg3,
  5. Andriana Barisic4,
  6. Martin Dawes5,
  7. Eva Grunfeld6,7,
  8. Nigel Hart8,
  9. Richard D Neal9,
  10. Marie Pirotta10,
  11. Jeffrey Sisler11,
  12. Gerald Konrad12,
  13. Berit Skjødeberg Toftegaard13,
  14. Hans Thulesius14,
  15. Peter Vedsted15,
  16. Jane Young16,
  17. Willie Hamilton17,
  18. The ICBP Module 3 Working Group*
    1. 1Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
    2. 2School of Medicine and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, UK
    3. 3Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
    4. 4Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
    5. 5Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
    6. 6Knowledge Translation Research Network Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
    7. 7Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
    8. 8School of Medicine, Dentistry and Biomedical Sciences—Centre for Public Health, Queen's University Belfast, Belfast, UK
    9. 9North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
    10. 10Department of General Practice, Primary Health Care Research Evaluation and Development, Carlton, Victoria, Australia
    11. 11Division of Continuing Professional Development, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    12. 12Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    13. 13Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
    14. 14Department of Clinical Sciences, Kronoberg County Research Council, Växjö, Sweden
    15. 15Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
    16. 16Department of Cancer Epidemiology, Public Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
    17. 17Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
    1. Correspondence to Dr Peter W Rose; peter.rose{at}


    Objectives The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.

    Design A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.

    Participants 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.

    Primary and secondary outcome measures Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.

    Results 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.

    Conclusions We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer—either directly, or by specialist referral, to improve outcomes.


    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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