Outcomes in 2748 patients referred to a colorectal two‐week rule clinic

Smith, Randall A.; Oshin, Olufemi; McCallum, Jane; Randles, Jane; Kennedy, Sue; Delamere, S; Rooney, P. S.; Carter, P. S.

doi:10.1111/j.1463-1318.2006.01048.x

Cited by 22 publications

(30 citation statements)

References 8 publications

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“…The majority (82%) of referrals met the criteria for assessment in the rapid-access clinic, indicating that primary care physicians are making appropriate use of resources by means of an established referral pathway and the use of a referral pro forma. In contrast, Smith et al 9 and Debnath et al 10 found that there was a very high proportion of nonconforming referrals (50%-62%). The reason for the high conformity of referrals in our unit may be due to a well-established and open relationship with GP practices, with the rapid access clinic now running for more than 15 years.…”

Section: Discussionmentioning

confidence: 89%

“…Whether the use of 2-week rule clinics has a positive effect on early diagnosis of CRC and subsequent survival rates and outcomes has been challenged. 9,16 This assumption was based on evidence that screening for CRC reduces mortality, therefore implying that early diagnosis confers an advantage on survival. 17 As early as 20 years ago, studies suggested a beneficial effect of a single flexible sigmoidoscopy as a screening tool for CRC.…”

Section: Discussionmentioning

confidence: 99%

“…Various authors have commented positively on the suitability and safety of the use of flexible sigmoidoscopy in establishing a diagnosis of distal colonic pathologies and excluding carcinoma, 6,7 while others have highlighted the need for flexible sigmoidoscopy in order for a onestop service to be effective and safe. 8,9 Queen Mary's Hospital (QMH) is a District General Hospital (DGH) situated in Kent and serving a population of approximately 300,000. Since its establishment, the rapid-access flexible sigmoidoscopy clinic averages 250 patients per year.…”

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confidence: 99%

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The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital

Sorelli

Iliadis

Payne

2014

International Surgery

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Historically rapid-access colorectal clinics have had high proportions of nonconforming referrals from primary care physicians, which calls into question the clinics' efficacy. We aim to determine the effectiveness of our rapid-access flexible sigmoidoscopy clinic, and the adherence to the referral guidelines for suspected bowel cancer by general practitioners. We performed a 3-month retrospective audit to evaluate (1) the proportion of patients seen within 2 weeks, (2) the appropriateness of referrals, (3) the proportion of patients with findings, and (4) the proportion of patients who had further tests. A total of 59 patients (19 male, 40 female; age 35-86 years) were included in the study. All were offered an appointment within 2 weeks. Forty-one cases (82%) were appropriate referrals. Twenty-eight patients (47%) had pathology at sigmoidoscopy. Cancer pick-up rate was 6%. Thirty-seven patients (74%) had further investigations. We determined that our rapid-access clinic for symptomatic patients has high diagnostic accuracy and that access to early investigation is being used appropriately by general practitioners. In the current climate of spending cuts and streamlining services, our study confirms we are meeting targets for delivery of our colorectal service. The majority of referrals under the 2-week rule are appropriate. Rapid access to early investigation is being used appropriately by general practitioners contrasting previous studies with high proportions of nonconforming referrals.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital

Sorelli

Iliadis

Payne

2014

International Surgery

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“…The cancer detection rate in our study was only 3%, which is much lower than other reported series, with rates of 6-14% in a 2WW population. [20][21][22][23][24][25][26] Our detection rate may have been influenced by the exclusion of male patients. However, there is a suggestion that detection rates are falling 27 with referrals increasing, particularly following the Be Clear on Cancer campaign in 2012.…”

Section: Discussionmentioning

confidence: 99%

“…Large numbers of patients are seen through this pathway but the literature shows that only 6-14% of patients referred via this route are diagnosed with cancer and this is decreasing over time. [20][21][22][23][24][25] Experience suggests that the secondary care system does not have the capacity for full investigation and management of the remaining patients with functional and benign colorectal disorders that may be identified. This could represent a potentially significant need for development of pelvic floor services.…”

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confidence: 99%

Prevalence of pelvic floor symptoms in female patients attending the two-week wait clinic with suspected colorectal cancer

Bennett

Greenwood

Durdey

et al. 2016

annals

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INTRODUCTION The aim of this study was to establish the prevalence of pelvic floor symptoms in women referred to a colorectal two-week wait (2WW) clinic with suspected colorectal cancer. METHODS A questionnaire assessing faecal incontinence (FI) (Wexner score) and obstructed defecation syndrome (ODS) (Renzi score) was offered to 98 consecutive female patients attending a colorectal 2WW clinic at a single trust. RESULTS Overall, 56 (57%) of the 98 patients had significant ODS and/or FI (scores >9/20), 33 (34%) had ODS and 40 (41%) had FI. Seventeen patients (17%) had both ODS and FI. Analysis of the 63 patients referred with a change in bowel habit (CIBH) showed 40 (63%) to be Renzi and/or Wexner positive compared with 16 (46%) of the 35 patients who presented without CIBH (p=0.095, Fisher's exact test). Further analysis showed that 31 (78%) of the 40 patients with FI presented with CIBH compared with 32 (55%) of the 58 without FI (p=0.032). In terms of ODS, 23 (70%) of the 33 patients with ODS presented with CIBH compared with 40 (62%) of the 65 without ODS (p=0.506). CONCLUSIONS Over half of the female patients attending our colorectal 2WW clinic had significant pelvic floor dysfunction (FI/ODS), which may account for their symptoms (especially in the CIBH referral category). While it is important for malignancy to be excluded, many patients may benefit from investigation and management of their pelvic floor dysfunction as the cause for their presenting symptoms.

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How important is it to investigate the whole of the colon after initial assessment at a rapid access colorectal clinic?

Lim

McGeever

Grey

et al. 2009

Int J Colorectal Dis

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Outcomes in 2748 patients referred to a colorectal two‐week rule clinic

Cited by 22 publications

References 8 publications

The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital

The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital

Prevalence of pelvic floor symptoms in female patients attending the two-week wait clinic with suspected colorectal cancer

How important is it to investigate the whole of the colon after initial assessment at a rapid access colorectal clinic?

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