Summary Background National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site‐specific fast‐track (2‐week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. Aims To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2‐week wait pathway. Methods A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta‐analysis; heterogeneity was assessed by I2. Results Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9‐8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4‐15.6), B = 36.7% (95% CI 30.8‐42.8), C = 35.7% (95% CI: 30.8‐40.8) and D = 11.1% (95% CI 7.3‐15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2‐62.8). Conclusions Only 7.7% of patients referred by the 2‐week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non‐2‐week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2‐week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.

BackgroundColorectal cancer represents the fourth most common cancer in England and Wales; survival is high for early stage disease but declines sharply with advanced stage. UK figures suggest that cancer survival rates are lower than those of other Western European countries. Current 5-year survival is around 50 %. A rapid access strategy was introduced through the Department of Health in 2000. This 2-week wait (TWW) referral pathway was devised to streamline referral for suspected cancer, allow diagnosis at an earlier stage, reduce cancer survival inequality and reduce cancer-related mortality. However, only around half of patients with colorectal cancer have symptoms that fit the TWW criteria plus there is a fourfold difference in referral rates across England and Wales.High-quality evidence of TWW outcome measures for colorectal cancer is lacking. This systematic review will collate and evaluate the latest evidence on colorectal cancer detection rate, stage at diagnosis and mortality.MethodsEnglish-language publications from 2000 reporting outcomes on the TWW referral system for suspected colorectal cancer will be eligible for inclusion. Cochrane, EMBASE, MEDLINE via PubMed, NHS Evidence, Trip and the British Library Catalogue databases will be searched. Two paired reviewers will independently screen all titles/abstracts and full text for eligibility, then extract data and assess for bias using standardised formats. They will hand review reference lists of eligible articles. Disagreement will be resolved via third party adjudication. Summary effect measures for post-referral diagnosis and mortality rates will be calculated and expressed as relative risk, hazard rate ratio or risk difference with corresponding 95 % confidence intervals. Where possible summary effect measures will be pooled, heterogeneity and its extent for pooled estimates will be assessed via visual inspection of forest plots and explored via sub-group analysis.DiscussionIn this systematic review, we aim to summarise the relevant evidence on cancer detection rate, cancer stage at diagnosis and disease-related mortality rates for patients with suspected colorectal cancer investigated through the TWW referral system in England and Wales. We will highlight gaps in the evidence and provide a better understanding of whether it is meeting its desired effect.Systematic review registrationPROSPERO CRD42016037368 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0358-6) contains supplementary material, which is available to authorized users.

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Results Total of 136 patients were diagnosed, 6 notes were not located. 60/130 had steroid treatment. 47/60 (78.3%) experienced significant bradycardia (Table 1). There was no statistically significant difference in the degree of bradycardia between the different dosages and types of steroids used. Infants were not at a significantly higher risk for bradycardia (n = 3). ECG on 11/47 patients showed either no change or sinus bradycardia. IOP was raised in 2/3 measured patients. Conclusions This is the first clinical study reviewing the clinical relevance of steroid induced bradycardia in paediatric cancer. Majority of patients on steroid treatment for cancer showed significant bradycardia with no clinical decompensation. No risk factors were identified with respect to dose, type of steroid or age group. We recommend correlation with BP, ECG, probably IOP measurement in the monitoring of patients on steroid treatment for cancer chemotherapy. Appropriate PEWS charting and escalation of management should still be followed. This is also the first study to document clinically relevant steroid induced glaucoma in paediatric malignancy treatment. This has led to a further collaborative study to investigate the interaction/mechanism of steroid induced glaucoma and bradycardia in paediatric malignancy.

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