Introduction The TWR referral pathway was first introduced in 2000 in an attempt to diagnose upper GI cancer at an earlier more treatable stage, to improve outcomes and mortality rates in the UK. However, a number of cases are still diagnosed through other referral routes including emergency admissions and routine referral. The aim of this study was to determine the route of referral for patients diagnosed with Oesophago-Gastric (OG) cancer and the effects, if any, on outcomes.
Method All patients newly diagnosed with an OG cancer between March 2013 to Sept 2014 at St George’s Hospital were identified using the histology database.
Patient demographics were obtained. The original source of referral of these patients was identified, including TWR referral, emergency admission or referral via another consultant. Presenting features were documented. The tumour site was recorded from the gastroscopy reports and the histology documented.
The staging and outcome with treatment intent, including curative, palliative or best supportive care was noted and reasons for this. The outcome of patients was compared to their mode of referral.
Results A total of 86 patients were diagnosed with OG cancer in the 18 month period from March 2013-Sept 2014. 57 (66%) were male. 13% were <55 years old.
43% had been referred through the upper GI TWR pathway, 33% were diagnosed after having been admitted as an emergency and 21% were referred from other consultants. Only one patient was diagnosed while being on Barrett’s surveillance programme.
Those that were diagnosed after an emergency admission tended to be older with 61% >75 years compared with 46% of those on the TWR pathway.
Of those that were referred through the TWR pathway, 52% had oesophageal cancer, 32% gastric cancer and 16% cancer at the GOJ. While 57% of patients diagnosed at an emergency admission had gastric cancer with 25% having oesophageal cancer.
Of those that had been diagnosed after an emergency admission, only one had curative treatment. 39% received palliative treatment (55% having palliative chemotherapy, 27% having a stent insertion and 18% having radiotherapy). While 54% had no active treatment given.
This compares to those diagnosed through the TWR pathway where 34% were treated with curative intent (22% with surgery and chemotherapy and 13% with radical chemo-radiation). 51% received palliative treatment with chemotherapy (68%), radiotherapy (26%), while only 11% had no active treatment.
Conclusion Many cancers are diagnosed outside of the TWR pathway though emergency presentation and referral from other consultants. The outcomes of patients referred through the TWR pathway are significantly better and there needs to be ongoing education and appropriate referral onto this pathway.
Disclosure of interest None Declared.
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