Introduction Colorectal cancer is the second largest cause of cancer death in the UK, and survival is significantly improved when diagnosed at an early stage; thus the call for earlier detection and faster referral. However, there are concerns that many cancers are still left undetected. This cross-sectional study aims to explore variations in the presentation and referral pathway for colorectal cancer patients in a district general hospital.
Method Data from 388 histologically proven colorectal cancer patients diagnosed between 1stJanuary 2012 and 31stDecember 2014 were analysed, and the method of presentation was reviewed. For patients presenting as elective admissions, their referral pathway was further analysed to establish the impact of faster referral methods, including 2 week wait and National Screening Programme. This was reviewed against the 4,950 patients referred to the trust as 2 week wait in the same time period. Finally, MDT outcomes were quantitatively analysed to explore the reasons why patients did not undergo surgical intervention for their cancer.
Results Of the 388 colorectal cancer patients, 34.3% (n = 133) presented through 2 week wait, 8.7% (n = 34) were referred through National Screening; 17.3% (n = 67) elective patients presented as routine. Of all the colorectal patients 32.7% (n = 123) patients were still presenting through emergency admissions.
Of the 4,950 patients who presented via 2 week wait in the 36 months analysed, only 2.7% (n = 133) had a positive cancer diagnosis. Quantitative analysis of management showed that of the 388 colorectal cancer patients, 53.4% (n = 207) underwent surgical resection as part of their management. Of the 181 patients who did not undergo surgical resection, 65.7% were due to the advanced stage of the cancer on presentation, and 21.9% were due to patient factors including co-morbidities and patient refusal.
Conclusion Whilst the number of patients with colorectal cancer presenting through faster referral methods is high, the percentage of positive 2 week wait referrals is very low; and a worrying amount of patients are still presenting through emergency admissions. Furthermore, there are large amounts of patients presenting who do not undergo surgical intervention. Overall this would suggest that despite the 2 week wait and National Screening Programme, many patients are presenting late with cancer, or indeed being missed all together in the community.
Disclosure of interest None Declared.
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