ARE GI CANCERS BEING DIAGNOSED FROM OUTSIDE THE ´URGENT CANCER´ REFERRAL PATHWAY?

Aims The UK lags behind Europe in the diagnosis of cancer. Patients with alarm symptoms are referred on a ´Two week wait´ (2WW) urgent pathway. 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. Known malignancies were excluded (n = 72).

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. referral/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%) patients went ´Straight To Test´ (STT) whereas 198 (62.5%) patients were seen in clinic first (153 (76%) of the GP Target 2WW group). The mean time to diagnosis in those referred via the GP Target 2WW was 25.4 days (STT) versus 32.2 days (clinic review prior), (p = 0.05).

Conclusions We conclude that 2 out of 3 GI cancers were diagnosed via the 2WW pathway but only one third of gastric cancers. Of all patients referred via the 2WW, three-quarters 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 diagnosis. We recommend 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.