Evaluating the two-week wait referral system for bowel cancer
Research type
Research Study
Full title
Evaluating the two-week wait referral system for bowel cancer
IRAS ID
248957
Contact name
Michel P Coleman
Contact email
Sponsor organisation
London School of Hygiene and Tropical Medicine
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Expedited pathways for diagnosing and treating cancer were introduced in England in the 2000 National Health Service Cancer Plan to avoid delays in cancer management and to improve cancer outcomes. Several waiting times targets were established, such as a maximum of 14 days between an urgent GP referral and an appointment in secondary care (“two-week wait”, TWW), and GP referral guidelines that established criteria for referral for investigation of patients with symptoms suggestive of cancer.
These strategies have resulted in a substantial increase in referrals from primary to secondary care, having a considerable effect on hospital waits and on healthcare professionals’ workload. Some authors argue, however, that there is limited predictive value of the symptoms suggestive of cancer in primary care patients, and little evidence supporting the choice of waiting times targets. Current evidence of the benefits of these strategies to cancer patients is conflicting, with several studies showing no improvement in earlier diagnosis with the TWW.
This project aims to understand whether the TWW has provided any benefits to colorectal cancer patients. We would like to examine whether the TWW is associated with improvements in diagnostic investigation, stage distribution, treatment and short-term mortality. We propose to use innovative analytical techniques to consider what would have happened to patients diagnosed through the TWW in terms of cancer outcomes, had they been diagnosed through a non-urgent referral. We propose to analyse detailed clinical information from various data sources, including a database of all patients referred by their GP to the colorectal surgical outpatient clinics since 1986, in Portsmouth NHS hospitals.
We will contribute to the literature on this matter by producing one peer-reviewed publication. Additionally, we intend to organise a workshop with relevant healthcare professionals, to discuss the findings, and to get a better understanding on how population-based research may help with their decision-making.
REC name
Yorkshire & The Humber - South Yorkshire Research Ethics Committee
REC reference
19/YH/0109
Date of REC Opinion
2 Apr 2019
REC opinion
Favourable Opinion