Updated 'two-week wait' referral guidelines for suspected colorectal cancer have increased referral volumes without improving cancer detection rates

Introduction: In November 2015, the National Institute for Clinical Health and Care Excellence updated its two-week wait (2WW) referral guidelines for suspected colorectal malignancy. This study measured the effect of the change in 2WW referral guidelines on: (i) the volume of 2WW referrals, (ii) th...

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Bibliographic Details
Published inBritish journal of medical practitioners Vol. 12; no. 2
Main Authors Jones, Christopher P, Fallaize, Rebecca C, Longman, Robert J
Format Journal Article
LanguageEnglish
Published J M N Medical Education Ltd 01.06.2019
Subjects
Cancer
Colorectal cancer
Diagnosis
Medical records
United Kingdom
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Summary:Introduction: In November 2015, the National Institute for Clinical Health and Care Excellence updated its two-week wait (2WW) referral guidelines for suspected colorectal malignancy. This study measured the effect of the change in 2WW referral guidelines on: (i) the volume of 2WW referrals, (ii) the rates of detection of cancer in those patients referred to the 2WW service, and (iii) adherence to the referral guidelines. Methods and materials: A retrospective case note review of all colorectal cancer 2WW referrals during two periods (July to August 2015 and July to August 2016), to a large inner-city teaching hospital, was undertaken. Cancer detection rates were calculated based on diagnosis obtained from review of patient clinical records and were cross-referenced against the regional cancer registry database. Results: There was a significant increase in the numbers of patients referred to the colorectal 2WW service in the period following the change in guidelines (193 vs. 268, p<0.01). There was no significant change in the rate of colorectal cancer detection between the two periods observed (8.3% vs. 7.5%, p=0.75), although adherence to the referral guidelines increased (72% vs 89%, p<0.01). Conclusion: Changes to the 2WW referral criteria have led to an increased number of patients being referred, but have not resulted in a change in the rate of colorectal cancer detection. Further work should seek to assess the impact on survival rates from colorectal cancer, and to contextualise these findings with wider trends in non-2WW routes to diagnosis. Keywords: Colorectal cancer, Two-week wait
ISSN:1757-8515
1757-8515