Chaudhri, S.; Reay, E.; Nair, S.; Jones, L.; N ah, A.; Gonsalves, S.; Houng, H.; Horgan, A.F.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA40
Academic Journal
The two week cancer referral rule was introduced to minimise the delay in diagnosis of cancers and introduce a fast track pathway for management of these patients. It has had significant implications for colorectal surgical practice leading to increased pressure on clinic and endoscopy lists. All patients referred with symptoms suggestive of colorectal cancer over a 6 month period were studied. Patients were seen at the outpatient clinic, flexible sigmoidoscopy clinic, or a direct access rectal bleeding clinic (DARC). In addition all referrals sent via the two week guidelines for colorectal cancer during the same period were audited. Methods of referral and utilisation of investigations were analysed, including the waiting times, investigations performed, and outcome. Information was analysed for 709 patients. Of those patients referred via the two week rule (243), 80% were first seen at OPD and 97% underwent complete colonic investigation. Colorectal cancer was diagnosed in 6% of these patients, and all but one cancer would have been within range of a flexible sigmoidoscope. The cancer pick up rate was 6% and median time to histological diagnosis of cancer was 63 days (range 34-155). Referrals to the DARC (210) during the same period led to a diagnosis of CRC in 4.8%, with a median time to diagnosis of (x) days. Of 100 patients with colorectal cancer, 90% would have met the eligibility criteria for 14 day referral. Despite compliance with the two week rule, the diagnosis of colorectal cancer in this group of patients is delayed compared with patients where referral are made directly to Flexible sigmoidoscopy clinics. Given that 97% of these patients require complete visualisation of their colon it may be more appropriate to reorganise colorectal services so as to enable a greater number of patients to be assessed directly by means of endoscopic examination.


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