Prioritization of colorectal referrals: a review of the 2‐week wait referral system

Rai, Sajal; Kelly, Michael J.

doi:10.1111/j.1463-1318.2006.01107.x

Cited by 63 publications

(68 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 Similar figures pertain to colorectal cancer. 35 GPs are accused, probably correctly, of gaming the system by ensuring their patient qualifies for a 2-week-wait referral by fudging the NICE criteria. 35,36 At the same time, there is widespread concern that too many cancers miss the 2-week-wait route, and that they are diagnosed more slowly by following the other routes.…”

Section: Misconception 4: the Cancer Detection Rate In Clinics Shouldmentioning

confidence: 99%

“…35 GPs are accused, probably correctly, of gaming the system by ensuring their patient qualifies for a 2-week-wait referral by fudging the NICE criteria. 35,36 At the same time, there is widespread concern that too many cancers miss the 2-week-wait route, and that they are diagnosed more slowly by following the other routes. 8 However, to increase the number diagnosed within the 2-week-wait clinics requires a fall in the percentage of 2-week-wait referrals that are positive.…”

Section: Misconception 4: the Cancer Detection Rate In Clinics Shouldmentioning

confidence: 99%

See 1 more Smart Citation

Five misconceptions in cancer diagnosis

Hamilton

2009

Br J Gen Pract

104

View full text Add to dashboard Cite

Section: Misconception 4: the Cancer Detection Rate In Clinics Shouldmentioning

confidence: 99%

Section: Misconception 4: the Cancer Detection Rate In Clinics Shouldmentioning

confidence: 99%

Five misconceptions in cancer diagnosis

Hamilton

2009

Br J Gen Pract

104

View full text Add to dashboard Cite

“…[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. 26 In view of this, some studies have examined referral practice, finding variation in terms of compliance with guidelines 27,28 and that a quarter of patients referred via the 2WW system do not meet the criteria when seen in the clinic, 20 leading to calls for increased GP education on referral guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is a suggestion that detection rates are falling 27 with referrals increasing, particularly following the Be Clear on Cancer campaign in 2012. 26 In view of this, some studies have examined referral practice, finding variation in terms of compliance with guidelines 27,28 and that a quarter of patients referred via the 2WW system do not meet the criteria when seen in the clinic, 20 leading to calls for increased GP education on referral guidelines. The fact that 57% of the women attending our 2WW clinic had significant pelvic floor dysfunction may indicate a lack of transparent alternative pathways for appropriate benign colorectal and pelvic floor services.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…In the UK, various studies have been performed analyzing the results of ‘straight-to-test’ (STT) and ‘2-week wait’ (TWW) referral systems [18,19,20,21]. Both methods have their pros and cons.…”

Section: Discussionmentioning

confidence: 99%

Benefits of a Well-Structured Diagnostic Process in Colon Cancer

Klemann

Wolters²,

Konsten³

2011

Dig Surg

View full text Add to dashboard Cite

Introduction: Preoperative work-up in colorectal cancer is comprehensive and can be time consuming. In our institution, the preoperative track for colorectal patients was reorganized in order to reduce the therapeutic delay and the number of outpatient clinic visits. We assessed the impact upon the patient outcomes. Methods: All consecutive patients with colon cancer who entered the reorganized preoperative track between January 2008 and December 2009 (n = 87) were retrospectively compared with a consecutively diagnosed traditionally evaluated patient group diagnosed between January 2005 and December 2006 (n = 108). Time between diagnostic procedures and surgery as well as needed number of preoperative outpatient department visits were calculated. All rectal malignancies, patients who received preoperative chemotherapy and/or radiotherapy and patients who underwent emergency procedures were excluded from analysis. Results: Time between colonoscopy and surgery was reduced from [median (25–75%)] 44 (34–54) to 27 (21–34) days, p < 0.001. The number of outpatient department visits declined from 6 (5–7) to 3 (3–4), p < 0.001. Time between first diagnostic test and colonoscopy was reduced from 44 (11–68) to 9 days (0–30), p < 0.001. Time between first diagnostic test and operation was reduced from 85.5 (56–120.5) to 42 days (28–62), p < 0.001. Before the reorganizations, 7% of colonoscopies were ordered by GPs and went up afterwards to 60%. Conclusion: Reorganization of traditional logistic routes for patients diagnosed with colon cancer reduces therapeutic delay and improves care. Moreover, the surgeon, gastroenterologist and oncologist can focus on the oncologic patient and his/her family instead of having to perform administrative tasks.

show abstract

Prioritization of colorectal referrals: a review of the 2‐week wait referral system

Abstract: The shortcomings of the TWW system in its original form have now been demonstrated beyond doubt. What is needed is a fresh approach to find a cost effective and viable alternative in a climate of increased expectations and finite resources.

Cited by 63 publications

References 29 publications

Five misconceptions in cancer diagnosis

Five misconceptions in cancer diagnosis

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

Benefits of a Well-Structured Diagnostic Process in Colon Cancer

Contact Info

Product

Resources

About