Trends in urgent referrals for suspected colorectal cancer: an increase in quantity, but not in quality

Abstract

INTRODUCTION An understanding of the volume of incoming referrals to a colorectal cancer (CRC) service is essential for adequate delivery of service. We hypothesised that the number of 2-week-wait (2WW) referrals has increased over recent years, with a concomitant increase in demand for endoscopic and imaging investigations. METHODS A retrospective review of all referrals from primary care with suspected malignancy to Barking, Havering and Redbridge NHS Trust (BHRNHST, London, UK) from 2009 to 2014 was undertaken. Annual numbers of CRC diagnoses, colonoscopies and CT scans among these patients were reviewed. Linear regression models were used to determine the significance of observed trends. RESULTS Annual number of 2WW referrals for all cancers increased steadily from 14,031 to 19,983 during the study period (p<0.01). Referrals for suspected CRC increased from 1,706 to 2,874 (p=0.02). Number of colonoscopies and CT scans carried out in 2WW patients also increased significantly. Proportion of patients referred as a 2WW diagnosed with CRC decreased from 7.9% in 2009 to 4.7% in 2014 (p=0.02). DISCUSSION Number of referrals for suspected cancer from primary care to BHRNHST is increasing steadily, which has implications for service provision. Prevalence of cancer diagnoses from these referrals is decreasing. CONCLUSIONS There has been a sustained and substantial increase in the number of urgent referrals for suspected CRC at BHRNHST over recent years, without an increase in the number of resulting cancer diagnoses.

Keywords: 2-week-wait; Cancer guidelines; Colorectal cancer; Referral; Service provision.

Figure 1

Trends in 2-week-wait (2WW) referrals for suspected malignancy at Barking, Havering and Redbridge NHS Trust (London, UK), 2009–2014. A: Number of referrals for all suspected malignancies. B: Number of referrals for suspected colorectal cancer. C: Number of colorectal cancer diagnoses among patients referred as a 2WW. D: Proportion of patients referred as a 2WW diagnosed with colorectal cancer. p-values are derived from linear regression models for trend.

Figure 2

Proportion of patients seen within 2 weeks of referral at Barking, Havering and Redbridge NHS Trust (London, UK), 2009–2014

Figure 3

Monthly number of 2-week-wait referrals with suspected colorectal cancer and clinic type at first appointment at Barking, Havering and Redbridge NHS Trust (London, UK), April 2014–March 2015. Dashed line denotes maximum number of allocated 2-week-wait clinic slots per month.

Figure 4

Monthly number of investigations carried out in patients referred as a 2-week-wait with suspected colorectal cancer at Barking, Havering and Redbridge NHS Trust (London, UK), April 2013–March 2015. p-values are derived from linear regression models for trend. A: Number of colonoscopies. B: Number of computed tomography scans.