Two-week urgent referrals for suspected childhood cancer: experience within a large tertiary centre

Delphi method to identify expert opinion to support children’s cancer referral guidelines

“…Of particular note, the original statement ‘the 2-week wait is an effective referral route for ensuring the prompt diagnosis of childhood malignancies’ was rejected outright with just 12% support. This is consistent with other reports which show it is not useful for paediatric cancer, with at most 1%–3% of referred patients ultimately being diagnosed via this route9–11 and, conversely, over 95% of children with cancer not reaching the paediatric haematology/oncology service through the 2-week wait system 12 13…”

“…Since only 1%–3% of children referred via this route are ultimately diagnosed with malignancy,9–11 this inevitably leads to unnecessary parental anxiety for the vast majority. Conversely, more than 95% of children with cancer do not reach the oncology service through the 2-week wait system 12 13…”

Suspected childhood cancer fast track: increasing referrals, diminishing returns

“…The 2 week fast track (2WFT) system is intended to help GPs identify features of childhood cancer, and mandates local hospital trusts with suitable specialists to see referred cases within 2 weeks. Other than a paper reporting fairly small numbers within a District General Hospital setting,2 and a follow-up letter from our institution reporting larger numbers,3 both published in this journal, there is a paucity of published data on the effectiveness of this system. Our initial letter3 reported figures over a 3 year period.…”

“…Other than a paper reporting fairly small numbers within a District General Hospital setting,2 and a follow-up letter from our institution reporting larger numbers,3 both published in this journal, there is a paucity of published data on the effectiveness of this system. Our initial letter3 reported figures over a 3 year period. We have continued to collect data, and have now analysed five consecutive years of activity, and have benchmarked our local figures against national data.…”

Towards evidence-based medicine for paediatricians

“…(There’s a similar issue with referrals with lymphadenopathy in particular for suspected lymphoma, with the ‘two week wait’ systems being shown repeatedly3–5 to have a very low positive predictive value. In this instance, the National Institute for Health and Care Excellence guideline6 states explicitly that in adults it’s working with a 2% pickup threshold and that in children it should be considerably lower.…”