Has the introduction of the '2 week rule' in the UK led to an earlier diagnosis of urological malignancy?

Patients undergoing primary surgery for oral and oropharyngeal cancer: how many are referred on the two-week wait pathway and by whom?

INTRODUCTION

Available data suggest that the two-week wait referral pathway is ineffective at expediting diagnosis of cancer due to large numbers of inappropriate referrals. This study aimed to compare the referral pathway of 125 patients who had undergone primary surgery for oral and oropharyngeal cancer with 100 who had been two-week wait referrals.

MATERIALS AND METHODS

This was a case note review.

RESULTS

Of the 125 patients who underwent surgery; 47 (38%) were referred via the 2WW pathway. GPs had referred 25 (53%) of the 47 patients and general dental practitioners 22 (47%). The tumour stage was similar regardless of referral pathway (two-week wait or routine). GPs recognised that the two-week wait pathway was needed in 49% of the patients they had referred, whereas the equivalent figure for GDPs was 40%. Of the 100 2WW patients, 52 were biopsied. Of these, nine (9%) were diagnosed with a malignancy. GPs referred 61% of the 100 two-week wait patients and accurately diagnosed five of the cancers (although two were basal cell carcinomas), general dental practitioners the remainder (including one basal cell carcinoma). Overall, 41% of the patients referred on the two-week wait pathway by GPs needed a biopsy, compared with 69% of those referred by general dental practitioners.

CONCLUSIONS

While the criteria for referral on the two-week wait pathway lack discrimination and the majority of referrals proved benign, nearly 40% of surgically treated patients were referred via this pathway, suggesting that it does serve a useful purpose. More patients with cancer were referred by GPs, but more two-week wait referrals by general dental practitioners warranted biopsy.

Impact of ‘two-week wait’ referral pathway on the diagnosis, treatment and survival in upper and lower gastrointestinal cancers

Background

The ‘two-week wait’(2WW) referral pathway was introduced in the United Kingdom to reduce waiting times for treatment of cancer. There has been a debate regarding the efficacy of 2WW pathway since its implementation.

Methods

A singleinstitutional analysis of upper gastrointestinal(UGI) and lower gastrointestinal(LGI) malignancies treated between 1April 2015 and 31March 2017 was undertaken to analyse the impact of 2WWreferral pathway on the diagnosis, treatment and survival.

Results

2WW referral does not achieve an earlier diagnosis compared with non-2WW routes of referral in UGI (χ2(3)=2.6, p=0.458) and LGI (χ2(3)=0.884, p=0.829) malignancies. 2WW referral does not lead to an improvement in curative treatment in UGI (OR1.48, 95%CI0.68to3.21, p=0.321) and LGI (OR1.59, 95%CI0.97to2.62, p=0.067) malignancies. No improvement in survival is seen in UGI (HR0.99, 95%CI0.56to1.75, p=0.963) and LGI (HR1.10, 95%CI0.60to1.99, p=0.764) malignancies by virtue of 2WW referral. Emergency presentation is the most common presenting route in UGI malignancy(40%) and is associated with poor survival (HR0.55, 95%CI0.30to0.97, p=0.045).Non-emergency route of presentation is associated with higher rates of curative treatment in UGI malignancies (OR3.49, 95%CI1.57to7.76, p=0.002). Lower rate of curative treatment (OR 0.27, 95%CI0.16to0.43, p<0.001) and poor survival (HR0.44, 95%CI0.26to0.76, p=0.003) is also observed in emergency presentation of LGI malignancy(29%) which is the secondmost common route of presentation in this group.

Conclusion

2WW referral does not achieve early diagnosis nor does it lead to an improvement in the rate of curative treatment in UGI and LGI malignancies. No improvement in short-term survival is seen in UGI malignancies nor in LGI malignancies on multivariate analysis by virtue of 2WW referral.

Clinical interval and diagnostic characteristics in a cohort of bladder cancer patients in Spain: a multicenter observational study

OBJECTIVE

We performed a cohort study in seven hospitals in Spain to determine the clinical characteristics of incident patients with bladder cancer, the diagnostic process, and the conditions that might affect health care interval times.

RESULTS

314 patients with bladder cancer were included, 70.3 (Standard Deviation [SD] 11.2) years old and 85.0% male. Clinical stage was T1 in 45.9% of patients. The median interval time between first consultation and diagnosis was of 104.0 days (Inter quartile range [IQR]:112.0; range from 0 to 986), being shorter for those patients who attended a hospital for their first consultation. The median interval time between diagnosis and first treatment was of 0.0 days (IQR: 0.0; range from 0 to 366), being longer when the patient had a pathologic tumor stage ≥ T2a.