Introduction The Cancer Access or ‘Red-Flag’ referral pathway was introduced to facilitate appropriate referral between primary and secondary care for cases of suspected cancer. Despite this, many cases of upper and lower gastrointestinal (GI) cancer are diagnosed through ‘routine’ referral grading, emergency presentations, and in the case of colorectal cancers, the bowel cancer screening (BCS) programme. The purpose of this study was to assess the original referral pathway for patients diagnosed with gastrointestinal cancer within our Health Trust and the effects, if any, on patient outcomes.
Methods We looked at a random sample of clinical notes of 107 patients diagnosed with a GI cancer between April 2011 and December 2012 within our trust (56 patients with lower and 51 patients with upper GI cancer) to determine referral source and grade, whether red-flag criteria were positive, staging and outcomes, whether curative or palliative.
Results 58 patients (54%) diagnosed with upper or lower GI cancer had been referred to the Trust via GP (with 22% seen initially at clinic and 32% at direct access endoscopy), 5 patients (5%) had been referred to clinic by another physician, 28 patients (26%) attended through casualty, 10 patients were diagnosed through the BCS programme (9%), 5 oesophageal cancers (5%) through Barrett’s surveillance, and 1 colorectal cancer (1%) through polyp surveillance. All 27 lower GI cancer patients initially referred by their GP had ‘red-flag’ symptoms, but only 12 (44%) were referred with an initial ‘red-flag’ grade; similarly, all 31 upper GI cancer patients initially referred by GP had ‘red-flag’ symptoms, but only 15 patients (48%) were initially referred as ‘red-flag’. Of the 51 upper GI cancer patients, 20 underwent curative treatment; 11 such patients were referred from GP (5 of which were originally referred as ‘red-flag’), 3 from another physician, 5 from Barrett’s surveillance and 1 casualty self-presenter. Of the 56 lower GI cancer patients, 33 underwent curative treatment – 17 referred from GP (only 7 originally referred as ‘red-flag’), 6 casualty self-presenters, and all 10 BCS patients (all Dukes’ A-B). Of the 54 palliative cases of either upper or lower GI cancer, only 15 of the 30 patients referred by their GP were referred through the ‘red-flag’ pathway.
Conclusion All patients diagnosed with a GI cancer that were originally referred from primary care had evidence to satisfy ‘red-flag’ referral, although less than half of these were referred through the ‘red-flag’ pathway. This study highlights the need for ongoing education and reinforcement of the ‘red-flag’ referral criteria.
Disclosure of Interest None Declared.