A study on the routes of referral for patients with colorectal cancer and its affect on the time to surgery and pathological stage

Trickett, J. P.; Donaldson, D. R.; Bearn, P.; Scott, Humphrey; Hassall, A. C.

doi:10.1111/j.1463-1318.2004.00665.x

Cited by 29 publications

(34 citation statements)

References 4 publications

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“…Of the patients whose investigation started in primary care, 27% had an emergency admission, which is similar to findings in other studies [25,26]. We found that the group with negative iFOBTs had a larger proportion (64%) of emergency admissions, indicating that a missed diagnosis in many cases resulted in acute illness.…”

Section: Discussionsupporting

confidence: 89%

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

Högberg

Karling

Rutegård

et al. 2013

Scandinavian Journal of Primary Health Care

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ObjectiveTo evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care.DesignA retrospective population-based study.Setting and subjectsAll 495 cases of CRC and adenomas with HGD diagnosed in the county of Jämtland, Sweden from 2005 to 2009.ResultsOf 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005).ConclusionIFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.

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Section: Discussionsupporting

confidence: 89%

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

Högberg

Karling

Rutegård

et al. 2013

Scandinavian Journal of Primary Health Care

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“…Another explanation may be that emergency referrals would never see a GP to allow a TWR referral to be instigated. Those articles quoting the proportion of GI cancer patients diagnosed via the A&E route state numbers ranging from 13.4% -35.3% for CRCs [12,14,15,17,19,21,27,31,32] and from 31% -41% for UGCs [37,39,40].…”

Section: Discussionmentioning

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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“…This metric may neglect the time taken for diagnosis and staging; as a result, actual wait times may be much longer than what is captured by administrative data. [3][4][5][6][7][8][9][10] Furthermore, several events may occur after the date of diagnosis which, although important in surgical planning, may negatively influence the date of surgery. Such events may include preoperative imaging, endoscopy, assessment of medical comorbidities and referral to specialists before consenting for surgery, all of which may increase surgical wait times during the patient journey.…”

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confidence: 99%

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Gillis

Dixon

Smith

et al. 2014

cjs

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Background: Administrative wait times reflect the time from the decision to treat until surgery; however, this does not reflect the total time a patient actually waits for treatment. Several factors may prolong the wait for colon cancer surgery. We sought to analyze the time from the date of surgical consultation to the date of surgery and any events within this time frame that may extend wait times. Methods:We retrospectively reviewed the cases of all adult patients in Ontario aged 18-80 years with diagnosed colon cancer who did not receive neoadjuvant therapy and underwent resection electively between Jan. 1, 2002, and Dec. 31, 2009. Wait times were measured from the date of surgical consultation to the date of surgery. We chose a wait time of 28 days, reflecting local administrative targets, as a comparative benchmark. We performed univariate and multivariate analyses to identify variables contributing to a waits longer than 28 days. Variables were analyzed in continuous linear and logistic regression models. Results:We included 10 223 patients in our study. The median wait time from initial surgical consultation to resection was 31 (range 0-182) days. Age older than 65 years had a negative impact on wait time. Preoperative services, including computed tomography, cardiac consultation, echocardiography, multigated acquisition scan, magnetic resonance imaging, colonoscopy and cardiac catheterization also significantly increased wait times. Wait times were longer in rural hospitals. Conclusion:Preoperative services significantly increased wait times between initial surgical consultation and surgery.Contexte : Au plan administratif, les temps d'attente sont le reflet de l'intervalle entre la prise de décision de traiter et la chirurgie elle-même. Toutefois, cette mesure ne tient pas toujours compte du temps total d'attente d'un patient pour son traitement. Plusieurs facteurs peuvent prolonger l'attente dans le cas d'une chirurgie pour le cancer du côlon. Nous avons voulu mesurer le temps écoulé entre la date de la consultation en chirurgie et la date de la chirurgie, et tout événement à l'intérieur de cet intervalle susceptible de prolonger les délais.Méthodes : Nous avons passé en revue de façon rétrospective le cas de tous les patients adultes ontariens âgés de 18 à 80 ans porteurs d'un diagnostic de cancer du côlon qui n'ont pas reçu de traitement néo-adjuvant et qui ont subi une résection non urgente entre le 1er janvier 2002 et le 31 décembre 2009. Les temps d'attente ont été mesurés entre la date de la consultation en chirurgie et la date de la chirurgie elle-même. Nous avons choisi un temps d'attente de 28 jours qui reflète les objectifs administratifs locaux comme valeur comparative. Nous avons effectué des analyses univariées et multivariées pour faire ressortir les facteurs qui contribuent à des périodes d'attente de plus de 28 jours. Les variables ont été analysées selon des modèles de régression linéaire et logistique continue.Résultats : Nous avons inclus 10 223 patients dans notre étude. Le temps d...

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A study on the routes of referral for patients with colorectal cancer and its affect on the time to surgery and pathological stage

Cited by 29 publications

References 4 publications

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness

A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

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