Introduction The volume of 2WW referrals continues to increase with little evidence of increased rates of cancer diagnoses or earlier stages of cancers . The Cancer Plan which introduced 2WW pathways and cancer treatment targets was intended to improve outcome for patients with sooner diagnoses and earlier stages of cancer found . We have observed the mortality risk and stage of oesophago-gastric (OG) cancer according to diagnostic referral route to see if 2WW pathways improve outcome for patients.
Method OG cancers diagnosed at Nottingham University NHS Trust between 1stJanaury 2015 – 31st December 2015 were identified from systematic searches of histopathological records, endoscopy database, radiological reports and registration at the Nottinghamshire OG Cancer MDT. Univariate logistic regression analysis was performed to determine the association between OG cancer mortality, stage of cancer with mode of referral. Kaplan Meier survival curves were used to describe mortality rate by stage of OG cancer and mode of referral.
Results 159 people were diagnosed with OG cancer with mean age 73.1 [SD 26.8] years. 52% (n=84) of OG cancers were diagnosed following 2WW referral with 24% (n=38) diagnosed following emergency presentation and unplanned hospitalisation. Patients diagnosed as an emergency had 4-fold increased risk of death at 1 year in comparison to those patients diagnosed along 2WW pathways (odds ratio 4.1 [95%CI 1.7, 9.7]). There was no difference in mortality risk in those referred along 2WW pathways to routine referral routes (p>0.05). Patients diagnosed as an emergency with OG cancer had 3-fold increased risk of stage 4 disease in comparison to those diagnosed along 2WW pathways (odds ratio 3.1; 95% CI 1.4, 6.8). There was no difference in the proportion of stage 4 OG cancer in those referred along 2WW pathways to routine referral routes (difference in proportion 7.0%; 95% CI −19.3, 28.2). Following review of performance status, co-morbidity and other patient factors, only 47% of patients from all routes of diagnosis were eligible for curative treatments.
Conclusion In keeping with recent literature on other tumour sites, emergency diagnosis of OG cancers is associated with higher stage at presentation . We are unable to demonstrate that diagnosis through 2WW pathways confers a lower stage at diagnosis or improved survival.
. Br J Cancer2016;115(7):866–75.
Disclosure of Interest None Declared
- cancer staging
- diagnostic pathway
- oesophageal cancer
- stomach cancer
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