Endoscopy waiting times and impact of the two week wait scheme on diagnosis and outcome of upper gastrointestinal cancer

Spahos, T; Hindmarsh, Andrew; Cameron, Evan Wm.; Tighe, M R; Igali, Laszlo; Pearson, D; Rhodes, Michael; Lewis, Michael P.

doi:10.1136/pgmj.2004.031104

Cited by 22 publications

(18 citation statements)

References 3 publications

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“…This should, in theory, have a negative impact on all other aspects of the service, although no evidence of this has been found to date. Three studies reported a decline in the routine endoscopy waiting lists following the introduction of the TWR [11,25,45], possibly due to an increased awareness of the guidelines for patient referrals, the more efficient organisation of services or the introduction of nurse endoscopists to cope with increased demand.…”

Section: Discussionmentioning

confidence: 99%

The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness

Thorne¹,

Hutchings²,

Elwyn³

2009

TOCOLCJ

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Aim: To systematically review the impact of the Two-Week Rule in increasing the pick-up rate of colorectal cancers and Upper Gastrointestinal (GI) cancers in the NHS. Materials and Methods:Data were combined for meta-analyses to determine (1) the Two-Week Rule pick-up rate for each cancer type and (2) the proportion of patients referred using the Two-Week Rule. Overall results were given as weighted averages.Results: There were 20 articles and 27 peer-reviewed abstracts included in this review. Colorectal Cancer: Only 9.5% of patients referred by the Two-Week Rule were eventually diagnosed with colorectal cancer (n = 24). When examining the referral origin of all colorectal cancer patients diagnosed during the time of 19 studies with this data, 32.2% had been referred using the Two-Week Rule. Upper GI Cancer: Only 5.5% of patients referred by the Two-Week Rule were eventually diagnosed with Upper GI cancer (n = 23). When examining the referral origin of all Upper GI cancer patients diagnosed during the time of 17 studies with this data, 23.6% had been referred using the Two-Week Rule. Conclusion:The Two-Week Rule is not sufficiently effective in diagnosing neither upper GI nor colorectal cancers in patients presenting to their General Practitioner.

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Section: Discussionmentioning

confidence: 99%

The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness

Thorne¹,

Hutchings²,

Elwyn³

2009

TOCOLCJ

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“…With little evidence that '2-week wait' initiatives impact on survival, 15,16 and growing pressure to find alternative mechanisms of improving services in general, onestop approaches are al ogical progression.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of a Novel One-Stop Testicular Clinic

Rochester

Scurrell

Parry

2008

annals

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Ann RC oll Surg Engl 2008; 90:5 65-570 565Prior to August 2004, general practitioners (GPs) in East Suffolk were able to investigate patients with scrotal disorders in several ways. Direct referral to the diagnostic imaging department for testicular ultrasound scan followed by ar eport by fax or mail involved several delays for the patient in the diagnostic pathway. Following this, referral to the urologydepartment may then have ensued, resulting in further diagnostic delay.A lternatively,i maging was arranged after consultationw ith as enior urologist, resulting in two separate department visits on three occasions in addition to their initial GP consultation. In 2003, the diagnostic imaging department received 560 requests for scrotal ultrasonography,a nd the waiting time for such ascan, if routine, was in excess of 20 weeks. It was possible, however,ifthe index of suspicion was high, for the investigation to be performed on the same day as the consultation.It was believed that the varied systems for patient evaluation provided neither the best quality service nor utilised resources with maximum efficiency.A ss uch, the patient pathway was redesigned to provide aone-stop service in an attempt to provide rapid and simpler diagnosis and instigation of definitive treatment. Funding was provided by the NHS Modernisation Agency'sA ction On Urology project. Men who were referred by their GP with at esticular or scrotal condition would be reviewed in aj oint sonographer and urology nurse specialist clinic provided entirely within the urology department with rapid open access. This service was to be provided in parallel with established urology general out-patient sessions where consultant urologists , the waitingt ime for routine scrotal assessment approached 6m onths in our hospital. The patients' diagnostic pathway was not uniform and involved several delays between general practitioner,r adiologist and urologist. If malignancy was suspected, patients were seen and assessed within 2w eeks. However,i tw as possible for patients with unsuspected malignancy to have their diagnosis delayed.

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“…However, the importance of medical delays for chronic diseases including cancer is inconclusive. Most studies found null impact of waiting time on cancer specific survival, including gastro-esophageal [7, 8, 16], colorectal [19], lung [20], and pancreatic [6] cancers. Other studies claimed however that a detrimental effect on the prognosis could be introduced if certain waiting time threshold was exceeded.…”

Section: Discussionmentioning

confidence: 99%

“…This was true even for relatively aggressive cancers, e.g. esophageal, gastric cancers [7, 8] and pancreatic cancer [6]. Yet, whether or not shorter waiting time for treatment influences other domains of cancer patients’ overall well-being is to a large extent unknown.…”

Section: Introductionmentioning

confidence: 99%

Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study

et al. 2017

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BackgroundExcept for overall survival, whether or not waiting time for treatment could influences other domains of cancer patients’ overall well-being is to a large extent unknown. Therefore, we performed this study to determine the effect of waiting time for cancer treatment on the mental health of patients with esophageal or gastric cancer.MethodsBased on the Swedish National Quality Register for Esophageal and Gastric Cancers (NREV), we followed 7,080 patients diagnosed 2006–2012 from the time of treatment decision. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles. Mental disorders were identified by either clinical diagnosis through hospital visit or prescription of psychiatric medications. For patients without any mental disorder before treatment, the association between waiting time and subsequent onset of mental disorders was assessed by hazard ratios (HRs) with 95% confidence interval (CI), derived from multivariable-adjusted Cox model. For patients with a preexisting mental disorder, we compared the rate of psychiatric care by different waiting times, allowing for repeated events.ResultsAmong 4,120 patients without any preexisting mental disorder, lower risk of new onset mental disorders was noted for patients with longer waiting times, i.e. 18–29 days (HR 0.86; 95% CI 0.74-1.00) and 30–60 days (HR 0.79; 95% CI 0.67-0.93) as compared with 9–17 days. Among 2,312 patients with preexisting mental disorders, longer waiting time was associated with more frequent psychiatric hospital care during the first year after treatment (37.5% higher rate per quartile increase in waiting time; p for trend = 0.0002). However, no such association was observed beyond one year nor for the prescription of psychiatric medications.ConclusionsThese data suggest that waiting time to treatment for esophageal or gastric cancer may have different mental health consequences for patients depending on their past psychiatric vulnerabilities. Our study sheds further light on the complexity of waiting time management, and calls for a comprehensive strategy that takes into account different domains of patient well-being in addition to the overall survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-3013-7) contains supplementary material, which is available to authorized users.

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Endoscopy waiting times and impact of the two week wait scheme on diagnosis and outcome of upper gastrointestinal cancer

Cited by 22 publications

References 3 publications

The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness

The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness

Prospective Evaluation of a Novel One-Stop Testicular Clinic

Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study

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