Introduction The two week wait (2WW) scheme for urgent assessment and investigation of suspected colorectal cancer is well established in the UK. The pick up rate from patients with alarm symptoms referred in this way runs at around 10%. The recent publication of surgeon-specific mortality from patients undergoing surgery for colorectal cancer has quite rightly focussed attention on the process of counselling patients about their risk.
Actuarial tables can be used to set the risk of dying from the disease or its treatment in context but may be misleading because they necessarily include the entire population rather than the typical patient sitting in the clinic.
The aim of this study was to describe a mortality risk for the typical patient referred as a colorectal 2WW irrespective of whether they are found to have the disease.
Method All 2WW referrals for the three months 01/03/13 to 31/05/13 were reviewed at one year from first clinic appointment. The hospital information (PAS) laboratory and electronic discharge systems were used to identify patients dying in this period.
The records of those who died were searched to identify whether they had been diagnosed with a colorectal malignancy, if they had undergone surgery and whether the death was related to the underlying diagnosis.
Actuarial tables were used to provide a comparison mortality rate for the similar age range.
Results 611 patients were referred in the three month period studied.
30 (5%) patients died within a year of first clinic appointment following referral. Median time from referral to death of these patients was 183 days (IQR 124.5–253 days)
Of the four (13%) patients found to have a colorectal malignancy two were operated, one with palliative intent and the other dying from cardiac causes post anastomotic leak.
The average age of patients’ referred was 70 years (std dev 12 years). The average age of those subsequently dying was 81 years (std dev 10 years)
From actuarial tables1the expected mortality rate at one year for men 70–74 is 0.0245% and for women is 0.016%
Conclusion The mortality of patients referred as 2WW colorectal cancers is far higher than would be expected by age alone. 5% vs <0.03%.
Of those who go on to die in the year following a 2WW colorectal clinic 87% never had a colorectal cancer.
Only 2 from 611 (0.3%) patients referred as 2WW died as a result of surgery for colorectal cancer.
The findings from this work are important to set into context the discussions around patients’ fears of colorectal cancer.
For the patient sitting in a 2WW colorectal clinic, the fact that the unit has an operative mortality of less than 2.5%2needs to be set against the underlying 5% mortality merely from having walked through the door.
Disclosure of interest None Declared.
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