K. M. Guest1, I. Nikolopoulos1, M. Kumari1, K. Thakur1 1Queen Elizabeth Hospital,General Surgery,London, LONDON, United Kingdom
Introduction: Incidence rates of colorectal cancer have risen very slowly for two decades, while mortality rates have fallen by over 25%. Incidence rates for breast cancer have continued to rise in the last 20 years chiefly among more affluent women, while mortality rates have fallen by one quarter. Suspected cancer waiting time targets were introduced in the UK to monitor service performance via process improvement. The intention was to improve the outcome (survival) of the disease. The “Two-Week Wait” system denotes that any patient with suspected cancer must be seen by a specialist within 2 weeks of referral. The aim of this study was to assess whether the Two-Week Wait target can improve survival in patients with colorectal and breast cancer.
Methods: 613 and 625 patients were diagnosed with colorectal and breast cancer respectively between January 2002 and December 2006. Data were retrospectively collected from the cancer database at Queen Elizabeth Hospital, England UK. Survival was compared in patients that were referred via the Two-Week Wait system (Group1) and those not referred via this pathway (Group2).
Results: Only 29% of colorectal cancer patients were referred under the Two-Week Wait rule, with the remainder a significant proportion coming from Accident & Emergency (n=131) and General Practitioners (n=144). The mean survival for Group 1 was 3.88 years (1415 days, 95% confidence interval 1283-1546 days) and for Group 2 was 3.41 years (1245 days, 95% confidence interval 1155-1331 days) (p-value=0.005). Kaplan-Meier comparison showed 2-year survival to be 71% for Group 1 and approximately 60% for Group 2.
44% of breast cancer patients were referred under the Two-Week Wait rule and of the remainder a significant proportion came from breast cancer screening (n=122) and GPs (n=135). The mean survival for Group 1 was 4.63 years (1690 days, 95% confidence interval 1604-1775 days) and for Group 2 was 5 years (1825 days, 95% confidence interval 1759-1891 days) (p-value=0.142). Kaplan-Meier comparison showed 2-year survival to be similar in both groups at approximately 83%.
Conclusions: The Two-Week Wait rule significantly improves the survival of patients with colorectal cancer. However the under-utilisation of this referral route cannot be ignored, as an unacceptably high percentage of colorectal cancer patients (30%) come via Accident & Emergency. On the other hand, the Two-Week Wait rule does not appear to affect the survival of patients diagnosed with breast cancer. A well established breast cancer screening programme can lead to equally good survival rates for those referred via the non-Two-Week wait route.