‘‘Two-Week Waits’’—Are They Leading to Earlier Diagnosis of Soft-Tissue Sarcomas?

Taylor, W.; Grimer, RJ; Carter, S. R.; Tillman, R. M.; Abudu, A.; Jeys, Lee

doi:10.1155/2010/312648

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…20 Three papers have now reviewed experience of this for patients with sarcomas and showed disappointingly that this does not seem to either speed up the process of diagnosis or reduce the size of the tumours at diagnosis. [21][22][23] The fact that the proportion of patients seen at the unit who had undergone a previous inadvertent excision has not changed is also depressing, as is the fact that the average size of these tumours has reduced. Surgeons are therefore still removing lumps without knowing what they are even though half of them are bigger than 5cm.…”

mentioning

confidence: 99%

Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis

Smith

Johnson

Grimer

et al. 2011

annals

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Earlier diagnosis is a key aim in achieving improved outcomes for patients with cancer. Bone and soft tissue sarcomas represent approximately 1% of all malignant tumours. Delays in diagnosis are frequent both because of their rarity and because the clinical features are easily confused with other conditions. In 2000 advice on earlier diagnosis was widely publicised. This study investigates how two factors that may act as a proxy for delay in diagnosis have varied over a 25-year period and whether there is evidence of improvement. Data on symptom duration and tumour size were collected prospectively on all new sarcoma patients referred to an orthopaedic oncology unit over 25 years. Data were available for 2,568 patients with primary bone sarcomas and 2,366 with soft tissue sarcomas. The mean sarcoma size at diagnosis was 10.7cm and 9.9cm respectively. The size of bone sarcomas had not changed over time but there had been a slight decrease in the size of soft tissue sarcomas (10.3cm before 2000 vs 9.6cm after 2000, p=0.03). The duration of symptoms reported by patients varied widely with a median of 16 weeks for bone sarcomas and 26 weeks for soft tissue sarcomas. The median duration of symptoms for bone sarcomas had actually increased since 2000 (16 weeks before vs 20 weeks after 2000, p<0.01). It remained unchanged for soft tissue sarcomas. These data show there is huge room for improvement in diagnosing bone and soft tissue sarcomas. New strategies are needed urgently.

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confidence: 99%

Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis

Smith

Johnson

Grimer

et al. 2011

annals

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“…Patient details and clinical information gleaned at the initial clinic appointment were entered onto the database. A previous study details the origin of referrals to our regional Sarcoma unit, with 16.4% being via two-week wait criteria and these had a 13% malignancy rate (Taylor et al, 2010).…”

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confidence: 99%

“…13 Despite a 25-fold increase in 2-week wait pathways we are not seeing improvement in early diagnosis or mean size at presentation. 14,15 Aims…”

Section: Introductionmentioning

confidence: 99%

If your lump is bigger than a golf ball and growing, think Sarcoma

Nandra

Forsberg

Grimer

2015

European Journal of Surgical Oncology (EJSO)

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“…8 Previous studies have challenged the effectiveness of the two-week wait system as the average size of the STS at time of diagnosis has not changed significantly since the introduction of the guidelines in 2000. 9,10 The following study was therefore performed with the aim to investigate: > How trustworthy is the general practitioner's (GP's) interpretation of the four features (size, pain, increase in size, depth) compared with the actual findings at a special unit for STSs? > Which of the four features is most predictive of malignancy?…”

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confidence: 99%

Evaluating the British sarcoma referral form

Smolle

Leithner

Grimer

2015

annals

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INTRODUCTION This study investigated the accuracy of general practitioner (GP) referrals under the two-week wait pathway for soft tissue sarcomas and whether the current National Institute for Health and Care Excellence criteria should be refined. METHODS All patients referred under the two-week wait system to one centre over the course of one year were reviewed. Comparison was made between the criteria identified by the GP and those confirmed by the centre to assess the accuracy of the referrals, and to identify what criteria predicted malignancy. RESULTS Overall, 135 patients were referred to our unit with a mean age of 56.4 years. Of these, 45 (33%) were found to have a malignant tumour. Factors identified by the GP were accurate in 74% of cases. The best predictor of malignancy was 'size >5cm' (76% sensitivity) while 'pain' was the least useful (27% sensitivity). Lowering the threshold for concern to a size of >4cm increased sensitivity to 89%. Although 106 patients had undergone some form of imaging prior to referral, this did not increase the likelihood of malignancy being detected. The combination of factors most likely to predict malignancy was a size of >5cm, increase in size, deep location and no pain (10 out of 13 referrals, 77% accuracy). CONCLUSIONS Based on the results of this study, we recommend an adaption of the existing features for concern. The new feature for concern should be 'size >4cm' and the factor 'pain' should be removed from the urgent referral form.

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‘‘Two-Week Waits’’—Are They Leading to Earlier Diagnosis of Soft-Tissue Sarcomas?

Cited by 11 publications

References 11 publications

Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis

Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis

If your lump is bigger than a golf ball and growing, think Sarcoma

Evaluating the British sarcoma referral form

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