The impact of the two-week wait scheme for suspected gastrointestinal cancers

Boulton-Jones, J. R.; Gamble, S.; Robinson, M.H.; Goddard, WP; Long, R. G.; Teahon, K

doi:10.7861/clinmedicine.3-5-483a

Cited by 9 publications

(8 citation statements)

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“…After critically appraising all articles and abstracts found in the literature search, there were 20 published research articles and 27 peer-reviewed abstracts with comparable data reporting on the effect of the TWR in NHS diagnostic services for GI cancers, of which two reported on both upper GI and colorectal cancers [6,7]. Tables 1 & 2 show all raw data collected for this study split according to cancer type: CRC data ( Table 1) and UGC data ( Table 2).…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…The choice of a threshold level for referral has considerable resource implications, with a lower threshold level requiring greater provision of investigative services. The percentage of colorectal cancers found in two reports of referrals to 2 week clinics was 9.4 and 16% (Boulton- Jones et al, 2003;Flashman et al, 2004). This suggests that the Referral Guidelines for Suspected Cancer -if they were used by the referring doctorshave a high specificity, but possibly at the cost of a low sensitivity.…”

Section: Symptomsmentioning

confidence: 90%

Clinical features of colorectal cancer before diagnosis: a population-based case–control study

et al. 2005

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Most colorectal cancers are diagnosed after the onset of symptoms. However, the risk of colorectal cancer posed by particular symptoms is largely unknown, especially in unselected populations like primary care. This was a population-based case -control study in all 21 general practices in Exeter, Devon, UK, aiming to identify and quantify the prediagnostic features of colorectal cancer. In total, 349 patients with colorectal cancer, aged 40 years or more, and 1744 controls, matched by age, sex and general practice, were studied. The full medical record for 2 years before diagnosis was coded using the International Classification of Primary Care-2. We calculated odds ratios for variables independently associated with cancer, using multivariable conditional logistic regressions, and then calculated the positive predictive values of these variables, both individually and in combination. In total, 10 features were associated with colorectal cancer before diagnosis. The positive predictive values (95% confidence interval) of these were rectal bleeding 2.4% (1.9, 3.2); weight loss 1.2% (0.91, 1.6); abdominal pain 1.1% (0.86, 1.3); diarrhoea 0.94% (0.73, 1

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“…Furthermore, the ''two week rule'' has led in many cases to a significant increase in referrals for endoscopy with a potential adverse effect on the routine non-urgent waiting times. 8 Improving outcomes in patients with oesophagogastric cancer in the UK may be achieved by earlier diagnosis; patients with stage 1 or 2 disease are most likely to benefit from surgery. The two week wait scheme would only have identified 35% of our patients with early stage disease even if scheme utilisation was 100%.…”

Section: Discussionmentioning

confidence: 99%

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

Spahos

Hindmarsh²,

Cameron³

et al. 2005

Postgraduate Medical Journal

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The NHS has introduced the two week wait scheme to detect upper gastrointestinal cancers at an early stage and improve survival rates The aim of this study was to assess the impact of this scheme and changes in endoscopy waiting times on tumour stage and resection rates over a four year period. Data were analysed prospectively for all patients diagnosed with oesophagogastric cancer between September 1998 and September 2002 and from those referred under the two week wait scheme since its introduction in 2000. Of those tumours diagnosed by this scheme (15%) only 5% were early disease (stage 1 or 2). Patients with early cancer, mainly diagnosed by routine gastroscopy, do not present with symptoms meeting the two week wait criteria. An increase in the resection rates for early disease will most probably be seen with a reduction in routine endoscopy waiting times.

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The impact of the two-week wait scheme for suspected gastrointestinal cancers

Cited by 9 publications

References 0 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

Clinical features of colorectal cancer before diagnosis: a population-based case–control study

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

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