Impact of urgent suspected cancer (USC) versus non-USC referral pathways on survival of upper GI cancers

Abstract

published guidance on 'Improving Outcomes in Upper Gastro-intestinal cancer' in January 2001. 1 One of the important recommendations was 'Fast Track Endoscopy' service within 2 weeks for patients with suspicion of cancer ('the 2 weeks rule'). Our aim was to compare the detection of curative Upper GI cancers (Oesophagus and stomach) and survival in patients referred for Oesophago gastro duodenoscopy (OGD) via USC versus non-USC (routine) route in a District general hospital. Methods We performed a retrospective audit on all patients referred for OGD between October 2006 and April 2007 in Wrexham maelor hospital (Cross-border Upper GI Cancer center for North Wales and West Cheshire). Data on mode of referral (USC or non-USC), endoscopic and histological diagnosis, curative or palliative intervention (if cancer detected) was collected. Patients with upper GI cancers were followed to check for survival at 18 and 36 months.

Prognostic consequences of implementing cancer patient pathways in Denmark: a comparative cohort study of symptomatic cancer patients in primary care

“…The few previous studies on the prognostic effect of urgent referrals among symptomatic cancer patients diagnosed through primary care display diverging results [ 18 – 26 , 34 ], which contrast our overall findings of improved prognosis across the time of the CPP implementation. A few of the previous studies did not observe a difference in prognosis [ 18 – 20 , 34 ]. Some studies concluded that urgent referrals either improved or worsened the prognosis, but they did not take into account the important issues of lead time bias and confounding by indication [ 21 – 26 ].…”

“…The prognostic benefits from implementing CPPs remain unknown for symptomatic cancer patients diagnosed through primary care, although this group constitutes more than 75% of all cancer patients [ 16 , 17 ]. The few existing studies are too small and underpowered to detect changes in survival [ 18 – 20 ], or they fail to recognise important issues of selection and confounding by indication related to the radical changes in referral routes [ 21 – 26 ].…”