The impact of the two-week wait referral pathway on rectal cancer survival

• Published in: Colorectal disease 2012-07, Vol.14 (7), p.848-853
• Main Authors: Currie, A. C., Evans, J., Smith, N. J., Brown, G., Abulafi, A. M., Swift, R. I.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chemoradiotherapy, Adjuvant; Disease-Free Survival; Female; government targets; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; National Health Service; Neoadjuvant Therapy; Neoplasm Staging; Prospective Studies; Radiotherapy, Adjuvant; rectal cancer; Rectal Neoplasms - diagnosis; Rectal Neoplasms - therapy; Referral and Consultation; referral pathways; Time Factors; United Kingdom; Waiting Lists
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2011.02829.x

Aim  The aim of this study was to compare the outcome of patients with rectal cancer referred through the two‐week wait (TWW) system with those identified by routine referral pathways (non‐TWW). Method  A prospective study was carried out of 125 consecutive patients diagnosed with rectal cancer between January 2000 and December 2005 (6 years) in one district general hospital. Data were recorded prospectively in a local clinicopathological registry. The patients were divided into two groups: group 1 (TWW) and group 2 (routine referral pathway). Results  Fifty‐two (41%) of the 125 patients were diagnosed through the TWW (group 1). There was no significant difference in patient demographics, including baseline tumour characteristics, between the two groups. There was no difference in preoperative or postoperative T stage between the two groups (P = 0.63). There was no significant difference in circumferential margin positivity (five of 52 in group 1 vs four of 73 in group 2; P = 0.52) or local recurrence rates (P = 0.37). The 5‐year all‐cause mortality was 49% for group 1 and 52% for group 2 (P = 0.3). The overall disease‐free survival was similar in the two groups (1521 days for group 1 vs 1591 days for group 1, P = 0.29). Conclusion  Referral under the TWW strategy does not translate into improved survival in rectal cancer.