Introduction According to NICE guidelines all patients with suspected cancer should be seen within 2 weeks of referral. Our Gastroenterology Department is experiencing an increasing workload burden due to a high number of suspected upper GI cancer referrals. We therefore decide to perform an audit to evaluate the nature, appropriateness and diagnostic findings of these referrals.
Method We reviewed 90 consecutive referrals from 26thSeptember 2013 to 4thNovember 2013. We focused our attention on duration of symptoms, type of symptoms and diagnosis.
Results 36 patients were male (40%) and 54 patients were female (60%) with a mean age of 64 years (range 32–89). The most common reason for the referral was weight loss, present in 42 patients (47%), followed by dysphagia, in 34 patients (38%) and iron deficiency anaemia (21 patients-23%). Other symptoms that prompted the referral were abdominal pain in 20 patients (22%), dyspepsia in 19 (21%), altered bowel habits in 12 (13%) nausea and vomiting in 11 (12%) and abnormal imaging in 7 (8%). The majority of patients presented with a duration of symptoms of <6 months (65 patients-72%) and 43 (47%) had a symptom duration of <2 months. Twenty-one patients (23%) had symptoms for >6 months and 7 had symptoms of >2 years duration (7%). Looking at appropriateness of referrals we took into account the duration of symptoms and evidence of recent investigations which had already excluded a malignant cause, and considered 17 (19%) of target referrals not appropriate.
Investigations didn’t reveal any pathology in 19% of the cases (17 patients). The most common finding was hiatus hernia, seen in 21 patients (23%), followed by gastritis, seen in 17 patients (19%). The cancer detection rate in our series was 10% (9 patients), 2 of the cancers were not gastrointestinal (1 renal, 1 lung). In few cases a diagnosis could not be reached because patients didn’t attend their appointments (6%).
Conclusion The cancer detection rate (10%) hasn’t improved over the last few years and is very similar to other GI cancers yields in literature.1The symptoms most predictive of upper GI malignancy were dysphagia, weight loss and iron deficiency anaemia (IDA). Weight loss and IDA were not seen as isolated symptoms in patients diagnosed with a malignancy. These results would suggest that our upper GI cancer referral guidelines should be reviewed in order to make a better use of our resources, perhaps focusing on a symptom spectrum more predictive of upper GI malignancy. We have also to point out that there is a high rate (19%) of referrals that could be made without using the target referral proforma.
Disclosure of interest None Declared.
Patel K, et al. Are upper gastrointestinal cancer two week referrals an appropriate use of National Health Service resources? Clin Med. 2011;11(4):412
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