Inter general practice variability in use of referral guidelines for colorectal cancer

John, S. K. P.; Jones, Oliver; Horseman, Nelson D.; Thomas, Peter; Howell, R. D.; Fozard, J. B. J.

doi:10.1111/j.1463-1318.2006.01201.x

Cited by 18 publications

(23 citation statements)

References 8 publications

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“…In addition up to 10% of GP consultations are due to abdominal pain and most will have a benign cause . The National Audit Office reported in 2010, a more than fourfold variation in 2‐week wait referral rates across England and Wales . GPs face an enormous challenge in balancing their referral behaviour with the knowledge that they are judged predominantly on their pick‐up rate of cancer.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Mozdiak

Ghebremichael‐Weldeselassie

McFarlane

et al. 2019

Aliment Pharmacol Ther

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Summary Background National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site‐specific fast‐track (2‐week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. Aims To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2‐week wait pathway. Methods A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta‐analysis; heterogeneity was assessed by I2. Results Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9‐8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4‐15.6), B = 36.7% (95% CI 30.8‐42.8), C = 35.7% (95% CI: 30.8‐40.8) and D = 11.1% (95% CI 7.3‐15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2‐62.8). Conclusions Only 7.7% of patients referred by the 2‐week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non‐2‐week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2‐week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.

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Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Mozdiak

Ghebremichael‐Weldeselassie

McFarlane

et al. 2019

Aliment Pharmacol Ther

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“…The number of 2wk referrals over the study period and the total number of CRCs diagnosed may seem relatively low, when compared with many other NHS hospitals serving larger populations [6]. This may reflect the younger average of the population in East London but it may also reflect the documented reluctance of some ethnic groups to seek medical attention and also perhaps the GP referral pattern [12–14].…”

Section: Discussionmentioning

confidence: 99%

The ‘straight to test’ initiative reduces both diagnostic and treatment waiting times for colorectal cancer: outcomes after 2 years

et al. 2009

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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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Inter general practice variability in use of referral guidelines for colorectal cancer

Abstract: This study demonstrates wide variability within primary care, in the appropriate use of colorectal cancer referral guidelines. General practices should be targeted for education.

Cited by 18 publications

References 8 publications

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

The ‘straight to test’ initiative reduces both diagnostic and treatment waiting times for colorectal cancer: outcomes after 2 years

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

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