Measuring performance in cancer services during COVID-19 and beyond: a novel case throughput metric using NHS Cancer Waiting Times data

BACKGROUND: Cancer Waiting Times (CWT) targets are a central instrument of cancer policy in England, yet conventional performance indicators often obscure changes in service throughput. The COVID-19 pandemic exposed limitations in existing monitoring approaches, particularly for assessing disruption and recovery across cancer pathways. METHODS: A novel case throughput metric (CTM) was developed by extracting National Health Service (NHS) England CWT data spanning 2017-23, covering 334 trusts and an average of 300 000 patients annually. The metric defines service throughput as the ratio of patient volumes meeting waiting time standards during defined periods of investigation normalized to a pre-pandemic baseline, enabling meaningful comparison across trusts while accounting for variation in trust sizes and pre-existing differences in service provision. RESULTS: The metric revealed substantial heterogeneity in both disruption and recovery across cancer pathways, with diagnostic and referral routes experiencing greater and more persistent throughput loss than treatment pathways. Recovery trajectories also varied markedly between regions, with exploratory analyses suggesting associations with sociodemographic factors. CONCLUSION: The CTM provides a policy-relevant complement to existing CWT indicators by making changes in service throughput explicit. It offers a practical tool for monitoring cancer system resilience and informing recovery planning during and beyond major system shocks.