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How has the ‘two‐week wait’ rule affected the presentation of colorectal cancer?
Author(s) -
Chohan D. P. K.,
Goodwin K.,
Wilkinson S.,
Miller R.,
Hall N. R.
Publication year - 2005
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2005.00821.x
Subject(s) - medicine , fast track , colorectal cancer , referral , cancer , retrospective cohort study , cohort , presentation (obstetrics) , emergency department , surgery , family medicine , psychiatry
Objective To assess the impact of the ‘two‐week wait’ rule on the presentation of colorectal cancer. Methods A retrospective study of all patients referred to a fast‐track clinic in a colorectal cancer centre over an 18‐month period, documenting outcome, especially colorectal cancer diagnosis. Comparison was made with patients diagnosed with colorectal cancer presenting via other routes in the same time period. Results Over an 18‐month period, 462 patients were seen in the fast‐track clinic and 64 (13.8%) were diagnosed with colorectal cancer. A further 131 patients with colorectal cancer presented to the department in the same time period through other means; 66 via standard out‐patient letters, 26 from other departments and 39 (20%) as emergency admissions. Median (range) time to first clinic was 12 (2–28) days for fast‐track and 24 (1–118) days for standard referrals ( P < 0.0001); median time to first treatment was a further 36 (9–134) and 36.5 (1–226) days, respectively. The fast‐track cohort had more advanced staging than those referred by standard letter. There were 19 Dukes' B, 22 Dukes' C and 14 Dukes' D cancers in the fast‐track group compared with 28 Dukes' B, 25 Dukes' C and 6 Dukes' D in the standard referral group. After patient interview, only 337 (73%) of 462 fast‐track patients appeared to fulfil the referral criteria but of the 64 diagnosed with cancer, 59 (92%) satisfied the criteria. Of the 66 patients with cancer referred by standard letter, 61 (92%) fulfilled the criteria. Conclusion Patients referred to the fast‐track clinic were seen quicker than those referred by standard letter, but they tended to have more advanced disease. The fast‐track referral criteria were fulfilled by most patients with cancer (whether or not they were referred to the fast track clinic), confirming their validity. After detailed interview in the clinic, a quarter of fast‐track referrals were found not to satisfy referral criteria, suggesting that prioritization in primary care could be improved.