ArticleAnnals of the Royal College of Surgeons of England2009
Referral letters for 2-week wait suspected colorectal cancer do not allow a 'straight-to-test' pathway.
Article in Annals of the Royal College of Surgeons of England, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method.BMC health services research · 2017Pooled it
- Outcomes of patients with non-lower gastrointestinal cancer diagnosed via the lower gastrointestinal two-week-wait service.Annals of the Royal College of Surgeons of England · 2023Article
- Prevalence of pelvic floor symptoms in female patients attending the two-week wait clinic with suspected colorectal cancer.Annals of the Royal College of Surgeons of England · 2016Article
- Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review.ESMO open · 2016Review
- Is the "red flag" referral pathway effective in diagnosing colorectal carcinoma?The Ulster medical journal · 2012Article
- Straight to colonoscopy: the ideal patient pathway for the 2-week suspected cancer referrals?Annals of the Royal College of Surgeons of England · 2011Article
- Does the two-week rule pathway improve the diagnosis of soft tissue sarcoma? A retrospective review of referral patterns and outcomes over five years in a regional sarcoma centre.Annals of the Royal College of Surgeons of England · 2010Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSome clinicians have argued that 2-week wait suspected colorectal cancer patients can go 'straight-to-test' to facilitate time to diagnosis and treatment. The aim of this study was to evaluate whether the currently used referral letters are reliable enough to allow that pathway. PATIENTS AND
methodsGeneral practitioner (GP) letters referring patients under the Two Week-Wait Rule for suspected colorectal cancer were prospectively reviewed over a 6-month period. Three examining consultants were asked to outline the tests they would perform having only read the letter, and then again after a clinical consultation with the patient. The outcome of these tests was tracked.
resultsA total of 217 referral letters of patients referred under Two Week Wait Rule for suspected colorectal cancer were studied. Having just read the referral letter, the most frequently requested test was colonoscopy (148), then CT scan (48), barium enema (44), followed by gastroscopy (23) and flexible sigmoidoscopy in 15 patients (some patients would have had more than one test requested). After consultation with the patients, tests requested as guided by the GP letter were changed in 67 patients (31%), where 142 colonoscopies, 61 CT scans, 37 barium enemas, 23 flexible sigmoidoscopies and 19 gastroscopies were organised. The referral indication which had tests changed most often was definite palpable rectal mass (67%), while patients referred with definite palpable right-sided abdominal mass had their tests least often changed (9%). A total of 22 patients were found to have colorectal cancers (10%) and 30 patients were diagnosed with polyps (14%). Out of 142 colonoscopies performed, 19 (13%) showed some pathology beyond the sigmoid colon and of the 23 patients who had flexible sigmoidoscopy initially, only three went on to have colonoscopy subsequently. During the 6-month period of the study, only five breaches of the waiting time targets were recorded (1 to the 31-day target and 4 to the 62-day target).
conclusionsA significant number of patients would have had tests changed after a clinical consultation. However, only a small number required further investigations having had a consultation prior to their initial investigations. We conclude that 2-week wait suspected colorectal cancer patients should be seen in the clinic first and should not proceed 'straight-to-test'.
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