The “two-week wait” referral pathway allows prompt treatment but does not improve outcome for patients with oesophago-gastric cancer

Sharpe, David; Williams, R.; Ubhi, S. S.; Sutton, Cd D.; Bowrey, David J.

doi:10.1016/j.ejso.2010.07.002

Cited by 36 publications

(30 citation statements)

References 22 publications

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“…The impact of waiting time for treatment has mostly been studied in terms of cancer survival among patients with esophageal or gastric cancer [8, 16]. To the best of our knowledge, this is the first large nationwide cohort study describing the association between waiting time for cancer treatment and mental health in patients with esophageal or gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…What little evidence exists on the short and long term effect of the TWR suggests no significant benefits in survival for CRC (17)(18)(19)(20)(21). This is most likely because those identified via the TWR present to their GP with classic symptoms of GI cancers which, whilst making them eligible for fast tracking and a reduced time to diagnosis and treatment, also mean that they are likely to be in the later, less treatable stages of the disease.…”

Section: Discussionmentioning

confidence: 99%

Has the Two Week Rule Improved Cancer Detection Rates for Gastrointestinal Cancers? A Systematic Literature Review

Thorne¹,

Hutchings²,

Elwyn³

2014

CCTR

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Introduction: The UK government introduced the two-week rule (TWR) to improve the diagnosis and treatment of gastrointestinal (GI) cancers. This updated review systematically identifies new articles since 2009 and presents an overview of the previous and new findings combined for both upper GI cancer (UGCs) and colorectal cancers (CRCs). Methods: We analysed all peer-reviewed articles and conference abstracts with GI cancer detection rates following TWR referral and/or the proportion of TWR-referred GI cancers from the total number diagnosed during the study period. We reported average cancer detection rates and split the data according to four time periods to determine whether TWR effectiveness improved over time. Results: The average cancer detection rate by the TWR for all studies was 11.6% for CRC and 8.3% for UGC. We found a decrease in cancer detection rates over time for CRC from 14.

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“…Recent studies on thyroid [9], colon [10] and Ó 2011 The Authors testicular [11] cancer have questioned the validity of the urgent suspected cancer pathway. Sharpe et al [12] investigated the cancer survival outcomes in oesophagogastric cancer patients referred via the TWW and routine referral pathways through their unit. Their findings echo those of our study in that despite shortening the time from referral to treatment there was no improvement in survival and a similar stage of disease at presentation.…”

Section: Discussionmentioning

confidence: 99%

The impact of the two‐week wait referral pathway on rectal cancer survival

et al. 2012

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The “two-week wait” referral pathway allows prompt treatment but does not improve outcome for patients with oesophago-gastric cancer

Cited by 36 publications

References 22 publications

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

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

Has the Two Week Rule Improved Cancer Detection Rates for Gastrointestinal Cancers? A Systematic Literature Review

The impact of the two‐week wait referral pathway on rectal cancer survival

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