Trends in urgent referrals for suspected colorectal cancer: an increase in quantity, but not in quality

Abstract

INTRODUCTION An understanding of the volume of incoming referrals to a colorectal cancer (CRC) service is essential for adequate delivery of service. We hypothesised that the number of 2-week-wait (2WW) referrals has increased over recent years, with a concomitant increase in demand for endoscopic and imaging investigations. METHODS A retrospective review of all referrals from primary care with suspected malignancy to Barking, Havering and Redbridge NHS Trust (BHRNHST, London, UK) from 2009 to 2014 was undertaken. Annual numbers of CRC diagnoses, colonoscopies and CT scans among these patients were reviewed. Linear regression models were used to determine the significance of observed trends. RESULTS Annual number of 2WW referrals for all cancers increased steadily from 14,031 to 19,983 during the study period (p<0.01). Referrals for suspected CRC increased from 1,706 to 2,874 (p=0.02). Number of colonoscopies and CT scans carried out in 2WW patients also increased significantly. Proportion of patients referred as a 2WW diagnosed with CRC decreased from 7.9% in 2009 to 4.7% in 2014 (p=0.02). DISCUSSION Number of referrals for suspected cancer from primary care to BHRNHST is increasing steadily, which has implications for service provision. Prevalence of cancer diagnoses from these referrals is decreasing. CONCLUSIONS There has been a sustained and substantial increase in the number of urgent referrals for suspected CRC at BHRNHST over recent years, without an increase in the number of resulting cancer diagnoses.

Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers

“…In the UK, CRC detection based on symptoms alone is low; ranging from 4% to 8% . This suggests that over 90% of patients undergo negative tests for exclusion of CRC.…”

“…This is further compounded by the fact that various threshold levels are applied and there is uncertainty surrounding those who test negative with FIT [15]. In the UK, CRC detection based on symptoms alone is low; ranging from 4% to 8% [16,17]. This suggests that over 90% of patients undergo negative tests for exclusion of CRC.…”

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

“…Of these, 1655 were excluded because they were not conducted in the UK or were not in accordance with NICE guidance. The full texts of the remaining 95 records were reviewed, of which 49 were included in the review . Of the 49 included publications, one reported two datasets from different centres .…”

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

“…47 In the UK, increasing diagnostic activity in the UK related to 'alarm' symptoms with a PPV ≥ 3% is already stretching diagnostic capacity. 48,49 In this study the approximate PPVs for a cancer diagnosis within 3 months in men aged ≥50 years and women aged ≥70 years with unexpected weight loss were 2.4% and 1.5%, respectively, rising to 3.0% and 1.9% over a 6-month period. Research is urgently required to identify patients with unexpected weight loss at greatest risk of cancer and other serious diseases to Fig.…”