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Fast-track referral for suspected cancer ‘saving lives’

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Use of the urgent referral pathway – the so-called two-week wait system – by general practices for patients with suspected cancer is saving lives, according to researchers.

The urgent referral pathway for patients with suspected cancer has been available in England since the early 2000s, but its use by practices varies considerably, noted the authors of the new study.

The researchers, led by Professor Henrik Møller from King’s College London, analysed data for 215,284 cancer patients from 8,049 practices who were diagnosed or first treated in 2009 and followed up to 2013.

They looked at three measures:

  • referral ratio – each practice’s use of the two week wait system compared with other practices
  • detection rate – percentage of cancers in a practice that were detected via the two week clinics
  • conversion rate – proportion of patients who went through the two week wait system and who were then shown to have cancer

The researchers found that practices with a high referral ratio and those with a high detection rate had reduced cancer mortality, although the conversion rate showed no association.

For example, patients from high referring practices had a 4% improved mortality rate, while patients from low referring practices had a 7% worse mortality rate, compared with patients from practices with intermediate referral rates.

The researchers estimated that an additional 2,400 patients from low referring practices might have been alive at the four year time point if use of urgent referral had been higher.

Results were consistent for the main types of cancer, with the exception of breast cancer.

“General practices that consistently have a low propensity to use urgent referrals could consider increasing the use of this pathway to improve the survival of their patients with cancer,” said the authors in the British Medical Journal.

“It is better to develop cancer in the United Kingdom now than it was 10 years ago”

William Hamilton

William Hamilton, professor of primary care diagnostics at Exeter University, said fast-track referral was one part of an improving picture of cancer diagnosis in the NHS.

“It is better to develop cancer in the United Kingdom now than it was 10 years ago – and improved diagnostic facilities are a part of the reason why,” he said. “It may be even better in another 10 years.”

However, he said that, while it was tempting to conclude that increased use of the urgent referral pathway led to lower mortality, some of the reported association could be explained by case mix.

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