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 22 April 2018

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News

The impact of two-week wait guidelines for suspected gastrointestinal cancers

Two-week waiting time guidelines in the NHS for gastrointestinal (GI) cancers are being met at the expense of a substantial increase in routine referral waiting time, and malignancies identified are often in advanced stages, the BSG annual conference in Scotland has been told.

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The two independent studies investigated the effectiveness of the two-week waiting time guidelines for suspected GI cancers. Both teams presented their research at the annual British Society of Gastroenterology Meeting, held this week in Glasgow, Scotland.

In the first study, researchers from the Scarborough Hospital, England investigated patients referred to a District General Hospital under the 'target' two-week waiting time.

Average waiting time (in days) for different types of referral:
Contemporaneous urgent: 18
Routine referrals (urgent): 26
Routine: 64
British Society of Gastroenterology Annual Meeting

Rates of malignancies and other serious non-neoplastic diseases, and waiting times of different types of referrals were compared.

Among patients referred within the two-week waiting time standard, 15% had proven malignancy and 25% had serious non-malignant disease. Average waiting time was 7 days; 95% of patients were seen within 2 weeks.

The other referral groups included contemporaneous urgent, routine referrals deemed urgent by the consultant, and routine. Malignancy rates for these groups were 8%, 15%, and 2%, respectively, and rates of serious non-malignant diseases were 20%, 30%, and 12%. The average waiting times were found to be 18, 26, and 64 days, respectively.

The researchers, led by S. Moreea, concluded that the two-week waiting time standard is being met at the expense of a substantial increase in the waiting time for routine referrals, whilst not necessarily identifying treatable cases of cancer.

In the second study, a team from the Northern General Hospital, Sheffield, England, investigated referrals for upper GI cancer under the two-week waiting time.

Out of a total of 63 patients who were referred under the two-week wait scheme, only 11% had a final diagnosis of cancer.

Of these cancer cases, the mean delay to diagnosis was 7 days. All were seen within 2 weeks. At 2 months follow-up 4 were still alive and 3 had died. Only 2 patients had surgery for potentially curable disease.

8 other patients who were not referred by the two-week scheme had upper GI cancers diagnosed during the same period. One of these was operable.

The authors concluded that cancer patients can be seen and a diagnosis made within a short period to comply with 2-week wait guidelines. Unfortunately, many of the symptoms highlighted in the guidelines suggest advanced disease. An improvement in outcome has yet to be demonstrated.

British Society of Gastroenterology Annual Meeting
19 March 2001

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