PTU-073\u2005Are gi cancers being diagnosed from outside the ‘two week wait’ referral?

Abstract

Introduction The UK lags behind Europe in the diagnosis, treatment and survival rates of cancer. To improve on this and diagnose cancer early, patients with alarm symptoms from primary care are referred on a ‘Two week wait’ (2WW) pathway. Previous data indicates that the majority of cancers diagnosed in the UK are from outside the 2WW pathway. However, demand for upper and lower GI endoscopy via the 2WW has risen dramatically above and beyond the steady increase in overall GI cancer incidence. We aimed to study the diagnostic pathways via which GI cancers are diagnosed. Methods We reviewed the common luminal upper and lower GI cancers diagnosed at endoscopy at a single centre between February 2017 and September 2018 via Unisoft GI Reporting Tool. Known malignancies and diagnoses made at other Trusts were excluded (n= 72). Retrospective analysis of 317 patients with 332 GI cancers was performed. Results 332 GI cancers (oesophagus 44 (13.9%), stomach 21 (6.6%), duodenum 6 (1.9%), colon 174 (54.9%), rectum 87 (27.4%)). Mean age 71.1 (range 24 - 97), Female 133 (42.0%). Median time to diagnosis (i.e. presentation to endoscopy) was 22 days (IQR 14 to 34). Referral pathways included 202 (63.7%) GP Target 2WW, 45 (14.2%) Inpatient, 30 (9.5%) Urgent 2WW from clinic/hospital discharge, 21 (6.6%) Abnormal imaging, 17 (5.4%) Routine clinic, 2 (0.6%) Surveillance. Only 48 (15.1%) GI cancer patients went ‘Straight To Test’ (STT) whereas 198 (62.5%) were seen in clinic first. The mean time to diagnosis in those referred via the GP Target 2WW was 25.4 days (STT) versus 32.2 days (clinic review), (p = 0.05). Abstract PTU-073 Table 1 Pathways to diagnosis for individual GI cancers (+ STT/clinic/A&E) All GI Cancers (n= 332) Oesophagus n= 44 Gastric n= 21 Colon n= 174 Rectum n= 87 p value Age (mean, s.d) 71.1 (13.5) 73.8 (11.6) 71.8 (17.8) 71.5 (13.2) 68.0 (13.7) 0.10 Time to diagnosis (median, IQR) 22 (1–4) 19 (–8) 11 (–8) 24.5 (1–8.75) 23 (1–3) 0.27 GP ‘2WW’ Pathway (%) 202 (63.7) 25 (56.8) 7 (33.3) 109 (62.6) 69 (79.3) 0.0003 STT (%) 48 (15.1) 9 (20.5) 2 (9.5) 24 (13.8) 13 (14.9) 0.63 Curative Treatment (%) 204 (64.4) 13 (29.5) 2 (9.5) 129 (74.1) 65 (74.7) < 0.00001 Conclusions In this study, we conclude that two thirds of GI cancers were diagnosed following referral via the 2WW pathway but only one third of gastric cancers. Of the 2WW patients, two thirds had a clinic review prior to endoscopy which resulted in a 7 day delay in cancer diagnosis compared to STT patients. We conclude that more patients with cancer are diagnosed on the 2WW pathway than previously documented and triaging patients STT speeds up the diagnosis further by 7 days. We recommend that the majority of 2WW patients be triaged STT so that earlier diagnosis of cancer may result in improved survival and reduce the gap compared to our European counterparts.