Straight-to-test for the two-week-wait colorectal cancer pathway under the updated NICE guidelines reduces time to cancer diagnosis and treatment

Abstract

Introduction The 2015 National Institute for Health and Care Excellence guidelines widened the referral criteria for the two-week-wait pathway for suspected lower gastrointestinal cancer. We implemented a straight-to-test protocol to accommodate the anticipated increase in referrals. We evaluated the impact of these changes for relevant pathway metrics and clinical outcomes using a retrospective cohort study with historic controls. Materials and methods We analysed data from all patients referred to a teaching hospital via the two-week-wait pathway for suspected lower gastrointestinal cancer under the previous guidelines between 1 March and 31 August 2015 compared with the same period in 2016, when the updated guidelines and straight-to-test protocol had been implemented. Results In the 2015 cohort, there were 64 cancer diagnoses from 664 referrals (9.6% pick-up) compared with 58 cancer diagnoses from 954 referrals in the 2016 cohort (6.1% pick-up). Our straight-to-test protocol reduced the median time to cancer diagnosis by 12.5 days (P < 0.001) and reduced the median time to cancer treatment by 7.5 days (P < 0.05) An increased proportion of non-colorectal cancers were diagnosed in 2016 compared with 2015, (37.9% vs 17.2%, P < 0.05) and more adenomas were removed in 2016 compared with 2015 (377 vs 193). Discussion and conclusion Our straight-to-test protocol has resulted in a reduction in times to cancer diagnosis and cancer treatment, despite an increase in the number of referrals. The new referral criteria have considerable resource implications, but their implementation did not result in an increase in the total number of cancers diagnosed.

The effectiveness of the Guy’s Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients

“…This study confirms better cancer detection rates comparable to straight-to-test models 17 , 24 , 25 , 27 , 28 and exceeds many 2WW pathways. 39 , 40 Only 16% of new cancers fulfil a 2WW referral criteria. This highlights the difficulty for GPs to identify the appropriate referral route and the importance of a vague symptom pathway.…”

Patient experiences of the urgent cancer referral pathway—Can the NHS do better? Semi‐structured interviews with patients with upper gastrointestinal cancer

“…In this study, a pathway variation was apparent, with some patients gaining direct access to testing, whilst others were surprised by initial specialist appointments before being sent for tests. This has also been identified in an endoscopy patient experience study 58 and highlights a potential area for improvement, as previous literature has identified that a straight‐to‐test protocol results in a reduction in times to cancer diagnosis and cancer treatment 59,60 . In addition, GP direct access testing performed as well as, and on some measures better than, consultant‐triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction 61 …”

“…This has also been identified in an endoscopy patient experience study 58 and highlights a potential area for improvement, as previous literature has identified that a straight-to-test protocol results in a reduction in times to cancer diagnosis and cancer treatment. 59,60 In addition, GP direct access testing performed as well as, and on some measures better than, consultant-triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction. 61 At the referral stage, whilst health-care professionals may not want to create unnecessary anxiety for patients, previous research suggests fear can actually be increased if the patient feels unclear or unprepared for the cancer referral pathway.…”

COVID-19 recovery: tackling the 2-week wait colorectal pathway backlog by optimising CT colonography utilisation

“…The clear benefits of STT cancer pathways have been reported in many studies. 21 , 22 , 23 The only published data specific to implementing a STT CTC service for symptomatic colorectal patients is from Leicester General Hospital. 21 This pathway was offered to all patients >60 years with an CIBH and iron-deficiency anaemia (IDA), and in 12 months, 1,792 STT CTC examinations were performed.…”