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The two-week wait guideline for suspected CNS tumours: a decade analysis
1Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK. dizhalfa@gmail.com
British Journal of Neurosurgery
|March 12, 2013
Summary
The two-week wait (2WW) guideline for suspected brain tumors shows stable, low compliance and detection rates over a decade. Adding cognitive decline assessment may improve detection of central nervous system (CNS) tumors.
Area of Science:
- Neuro-oncology
- Public Health Policy
- Health Services Research
Background:
- The two-week wait (2WW) referral guideline for suspected central nervous system (CNS) tumors was implemented over a decade ago to expedite cancer diagnosis and improve survival rates.
- Previous studies indicated suboptimal compliance and low detection rates for this guideline.
- This study provides a ten-year analysis of referral patterns, guideline compliance, and detection rates.
Purpose of the Study:
- To analyze referral patterns for suspected CNS tumors over a decade using the 2WW pathway.
- To evaluate the compliance and detection rates of the 2WW guideline over a ten-year period.
- To identify potential improvements for the 2WW guideline.
Main Methods:
- Retrospective analysis of patients referred via the 2WW pathway for suspected CNS tumors between 2002 and 2011.
- Data collection included referral letters, case notes, radiographic images, and outcomes.
- Analysis of trends in waiting times, time to diagnosis, compliance, and detection rates.
Main Results:
- No significant changes in waiting time, time to diagnosis, compliance, or detection rates were observed over the decade.
- Of 85 2WW referrals, 41.2% were non-compliant, and 21.2% identified CNS tumors.
- Guideline compliance correlated with higher detection rates (32.0% vs. 5.2%). Non-compliant referrals detecting tumors often involved patients with cognitive decline.
- The guideline demonstrated a sensitivity of 88.8% and specificity of 49.3%.
- The majority of CNS tumor diagnoses (98.4%) were made outside the 2WW pathway.
Conclusions:
- The 2WW guideline for suspected CNS tumors has shown no significant improvement in waiting times, diagnosis times, compliance, or detection rates over the past decade.
- While the 2WW pathway generates few referrals, it has a high positive detection rate.
- Incorporating cognitive decline assessment into the 2WW guideline may enhance the detection rate of CNS tumors.
