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Impact of ‘two-week wait’ referral pathway on the diagnosis, treatment and survival in upper and lower gastrointestinal cancers
  1. Matthew Fallon,
  2. Md Tanveer Adil,
  3. Kasim Ahmed,
  4. Douglas Whitelaw,
  5. Farhan Rashid,
  6. Periyathambi Jambulingam
  1. Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  1. Correspondence to Md TanveerAdil, Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton LU4 0DZ, UK; tanveer.cmc{at}gmail.com

Abstract

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.

  • gastrointestinal tumours
  • health policy
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Footnotes

  • Contributors MF and KA collected the data. MTA and PJ designed the analytical strategy. MTA and MF did the statistical analysis. MF and MTA wrote the article. MTA, DW, FR and PJ interpreted the findings and reviewed the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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