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Referral guidelines for colorectal cancer--do they work?
A James Eccersley1, Elena M Wilson, Andreas Makris
1Luton & Dunstable Hospital, Bedfordshire, UK.
Annals of the Royal College of Surgeons of England
|March 22, 2003
Summary
New urgent referral guidelines for colorectal cancer (CRC) show promise, with patients meeting criteria having a higher cancer diagnosis rate. However, most CRC cases are diagnosed outside this system, highlighting a need for broader diagnostic support.
Area of Science:
- Oncology
- Gastroenterology
- Public Health
Background:
- Urgent referral guidelines for suspected colorectal cancer (CRC) were implemented in 2000.
- Assessing the impact of these guidelines on referral patterns and cancer detection rates is crucial for improving diagnostic pathways.
Purpose of the Study:
- To evaluate the effectiveness of urgent referral guidelines for suspected colorectal cancer.
- To determine the number of urgent referrals received and the proportion of patients diagnosed with cancer under these guidelines.
Main Methods:
- Prospective assessment in a district general hospital.
- Analysis of urgent referrals received over the first year post-implementation.
- Comparison of cancer diagnosis rates between patients who did and did not meet referral criteria.
Main Results:
- 180 urgent referrals were received; 95 (55%) met the guidelines, with 24 (25%) diagnosed with CRC.
- Only 2 of 85 patients (2%) not fitting guidelines had CRC.
- The majority of new cancers (119/145, 82%) were diagnosed in patients not referred urgently for suspected CRC.
Conclusions:
- The guidelines are effective for patients meeting criteria, indicating a significant cancer yield.
- Most colorectal cancers are identified through pathways outside the urgent referral system.
- Reducing diagnostic delays requires addressing patients who don't fit criteria, improving GP support, and enhancing specialist access.