Delay in referral to a specialist soft-tissue sarcoma unit

Clark, Matthew A.; Thomas, Joseph

doi:10.1016/j.ejso.2004.11.016

Cited by 71 publications

(63 citation statements)

References 11 publications

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“…Delays mostly occur prior to referral to a treatment centre. 4 It is of note that the two superficial sarcomas diagnosed on clinical grounds in the present series were around the reported median size at presentation for superficial tumours.…”

Section: Discussionmentioning

confidence: 72%

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

Pencavel

Strauß

Thomas

et al. 2010

annals

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INTRODUCTION The NHS Cancer Plan was introduced in 2000 and included guidelines for the rapid assessment and referral of cases of suspected malignancy. We wished to assess the efficiency and appropriateness of patients referred under the Department of Health's general practitioner referral guidelines implemented for sarcomas in December 2000. PATIENTS AND METHODS A retrospective case-note review was performed of all patients referred to our regional soft tissue sarcoma unit between 1 January 2004 and 31 December 2008. Patients referred under the two-week guidelines and all patients referred routinely were analysed. The main outcome measures were the total number of patients referred on the basis of the two-week guidelines and the proportion they constitute of all referrals. The referring criteria were noted and compared to the observed criteria recorded. The final histo-logical diagnosis of patients referred on the basis of the two-week guidelines are documented. RESULTS A total of 2746 referrals for suspected sarcoma were made from January 2004 to December 2008. Of these, 154 referrals were made under the two-week rule of which 102 were referred purely on the clinical criteria for suspected soft tissue sarcoma. The remaining patients were referred after non-urgent special investigations indicated the possibility of sarcoma. Twelve patients referred under the two-week rule were proved to have sarcoma, nine after specific investigations including imaging or histological diagnosis. Of the 102 patients referred on clinical suspicion of a sarcoma, two patients had proven soft tissue sarcomas and one patient a cutaneous sarcoma. Between 2004 and 2008, the number of 2-week referrals rose 25-fold but accounted for an increase of less than 1% of the sarcomas treated in this unit. CONCLUSIONS The numbers of all referrals for suspected sarcoma are increasing; however, the rate of increase of 2-week referrals is increasing faster than routine referrals and will exceed it in 2012 if current trends continue. There has not been a commensurate rise in the detection of sarcoma or, more specifically, diagnosis of the deep sarcomas associated with worse prognosis. Current clinical guidelines have essentially had no impact on the early diagnosis and treatment of soft tissue sarcoma, and may negatively impact on the treatment of patients with proven sarcoma by delaying treatment within a regional centre because of redirection of a large number of patients with benign abnormalities to such centres.

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Section: Discussionmentioning

confidence: 72%

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

Pencavel

Strauß

Thomas

et al. 2010

annals

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“…Delays in presentation, referral, diagnosis, and/or treatment in this and other tumours have been reported. [4][5][6][7][8] In this study, we focused on the initial symptoms at or before presentation with an osteosarcoma around the knee joint.…”

Section: Discussionmentioning

confidence: 99%

Initial Symptoms and Delayed Diagnosis of Osteosarcoma around the Knee Joint

Pan

Chan

Chia

2010

J Orthop Surg (Hong Kong)

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Purpose. To identify initial symptoms of osteosarcoma around the knee joint. Methods. Records of 19 men and 11 women aged 9 to 34 (mean, 17) years with osteosarcoma around the knee joint were reviewed. Each patient was interviewed (for a mean of 1.5 hours), and a detailed history of symptom onset recorded. Results. In all patients, the first symptom was pain, which was more pronounced on weight bearing in 16 (53%) of them and was worse at night in 11 (37%). Swelling was noticed in 28 patients (a mean of 7 weeks after pain onset). 16 (53%) of the patients had a history of minor trauma around the time of symptom onset. 20 (67%) of the patients had a limp, in 9 of whom it was not associated with pain on weight bearing; only 2 (7%) had a pathological fracture. The mean interval from the onset of symptoms (pain) to presentation was 10 (range, 0-49) weeks. The mean interval from Journal of Orthopaedic Surgery �� presentation to radiography was 3 (range, 0-20) weeks; in 8 patients this interval exceeded 3 weeks despite a noticeable swelling. The mean interval from radiography to referral to our hospital was 2 (range, 0-14) weeks. Together with the 2 weeks for diagnostic workup and biopsy, the mean total delay was 17 (range, 4-55) weeks. Conclusion. Physicians should be aware of the symptoms of osteosarcoma and promptly refer patients to tumour centres, especially adolescents, those who present with pain that may be worse at night and on weight bearing, and those in whom a swelling and/or a limp is evident.

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“…6 There is also evidence suggesting that, in certain specialties, some patients are not referred until their condition has reached an advanced stage. [7][8][9] Referral-management schemes have been a frequent response to problems of rising outpatient attendances and the associated cost, growth of specialty waiting lists, inappropriate referral, and variation in clinicians' referral rate and quality. [10][11][12] Ninety-one per cent of primary care trusts were using some form of referral management in September 2009.…”

Section: Introductionmentioning

confidence: 99%

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

Cox

Steel

Clark³

et al. 2013

Br J Gen Pract

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BackgroundNinety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. AimTo assess the impact of three referralmanagement centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and settingA retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. MethodThe age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. ResultsReferral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). ConclusionReferral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review.

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Delay in referral to a specialist soft-tissue sarcoma unit

Cited by 71 publications

References 11 publications

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

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

Initial Symptoms and Delayed Diagnosis of Osteosarcoma around the Knee Joint

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

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