TITLE

DYSPHAGIA AND THE 2 WEEK RULE: A HARD ACT TO SWALLOW?

AUTHOR(S)
Morris, D.L.; Ainsworth, A.; Leckenby, C.; McIntyre, P.B.; Greenfield, S.M.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA37
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Guidelines from the DOH guarantee a specialist sees everyone with suspected cancer within 2 weeks of urgent GP referral. Symptom guidelines for suspected upper Gl cancers were distributed. Aims: To evaluate the symptom guidelines for identifying oesophageal cancer. To assess delays in the patient pathway by comparing time from urgent referral to first hospital appointment (endoscopy or outpatients), before and after the guidelines were introduced, and waiting times to first endoscopy in those with benign and malignant dysphagia. Methods: Patients with oesophageal cancer were identified from PAS and endoscopy, for the 1 year before and after the guidelines were introduced. A sample of age/sex matched patients with benign dysphagia was identified for comparison. Case notes were reviewed. Results: 44 subjects with oesophageal cancer were identified, 21 before and 23 after guidelines introduced. 8 had 'curative' surgery. Symptom guidelines would have missed 3/23 GP referrals presenting with anaemia, haematemesis and weight loss without dyspepsia. Since guidelines, referrals to endoscopy with dysphagia (excluding outpatient visits) increased from 12 to 13 per month, but the benign:malignant ratio reduced from 6.4: to 4.6:1, suggesting better case selection. Since the guidelines, the mean waiting time to first consultant episode for urgent referrals found to have oesophageol cancer has increased from 19 (range 2-46) to 23 days (3-56), the percentage seen within 14 days dropping from 56 to 46%. The wait to first endoscopy has remained stable (33 days range 2-120). Non-urgent referrals with cancer also showed an increase in wait to first consultant episode from mean 27 (4-50) to 36 days (23-46), the percentage seen within 14 days dropping from 50 to 0%. The wait to first endoscopy has increased from mean 27 (4-50) to 65 (3-107) days. Waiting times have also increased for benign dysphagia. Conclusions: Identifying delays in the patient pathway may improve...
ACCESSION #
9747512

 

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