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.
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.
Authors: M Elisabeth Del Giudice; Emily T Vella; Amanda Hey; Marko Simunovic; William Harris; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275
Authors: M Elisabeth Del Giudice; Emily T Vella; Amanda Hey; Marko Simunovic; William Harris; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275
Authors: H Singh; C De Coster; E Shu; K Fradette; S Latosinsky; M Pitz; M Cheang; D Turner Journal: Can J Gastroenterol Date: 2010-01 Impact factor: 3.522
Authors: Robert T Padwick; Adeel A Bajwa; Annabel Shaw; Edmund Leung; James Francombe; Michael L Stellakis Journal: Int J Colorectal Dis Date: 2013-06-09 Impact factor: 2.571
Authors: Petra Jellema; Daniëlle A W M van der Windt; David J Bruinvels; Christian D Mallen; Stijn J B van Weyenberg; Chris J Mulder; Henrica C W de Vet Journal: BMJ Date: 2010-03-31
Authors: M Brouwers; T K Oliver; J Crawford; P Ellison; W K Evans; A Gagliardi; J Lacourciere; D Lo; V Mai; S McNair; T Minuk; L Rabeneck; C Rand; J Ross; J Smylie; J Srigley; H Stern; M Trudeau Journal: Curr Oncol Date: 2009-12 Impact factor: 3.677