TITLE

THE 2 WEEK STANDARD FOR SUSPECTED UPPER GI CANCERS: ITS IMPACT ON CANCER STAGING

AUTHOR(S)
Radbourne, D.; Walker, G.; Joshi, D.; Sheil, M.; Robertson, F.; Steger, A.; O'Donohue, J.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA116
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: The 2 week wait standard for suspected upper Gl cancer ('the standard'), introduced 1 July 2000, requires patients to be seen by a specialist within 2 weeks of referral. We aimed to investigate its impact on the pattern of referrals and clinical outcome. Methods: We identified patients referred with upper Gl symptoms belween 1 July 2000 and 31 December 2001, andupper Gl cancers from the cancer and histology databases. Outcomes were compared between patients referred by the standard and traditional routes. Results: Of 153 referrals under the standard (81 female, mean age 62 years), all but one were seen within 2 weeks. Quarterly referrals steadily increased from 12 in the first to 39 in the final quarter. 128 were first seen at endoscopy (3.5% of 3609 patients having endoscopy). The commonest presentations were dysphagia and weight loss. Cancer was diagnosed in 16 patients (7 female, mean age 68 years) (10.5% of referrals, 12.5% of those endoscoped), 10 on the initial endoscopy (5 oesophageal, 5 gastric) and six on investigations subsequent to normal endoscopy. 10 of the 16 patients (62.5%) were incurable (6 female, mean age 69 years) because of invasion or metastases. 6 cancers were curable (3 gostrectomies, 1 Whipple's, two chemoradiotherapy for oesophageal cancers). 93 other upper Gl cancers were diagnosed among patients referred by the traditional route (35 females, mean age 70 years; 23 oesophageal, 34 gastric, 36 pancreatic), from 3481 endoscopies (2.6%). Survival did not differ between traditional and standard groups: 55 of 93 (59%) vs 9 of 16 (56%) were dead at mean follow up 368 vs 335 days, respectively with mean survival of 18 weeks in both groups (p = NS for all comparisons). Conclusions: Compliance with the standard has been excellent. Referrals numbers reached a plateau last year and account for only 3.5% of total upper Gl endoscopies and 14.7% of upper Gl cancers. The yield of cancers among endoscopies performed under the standard...
ACCESSION #
9748069

 

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