Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 29;15(3):e36857.
doi: 10.7759/cureus.36857. eCollection 2023 Mar.

Two-Week Wait Gastrointestinal (GI) Cancer Pathway: A Single Tertiary Centre Experience During the COVID-19 Pandemic

Tareq Al Saoudi  1 , Suchita Bahri  1 , Farah Khasawneh  1 , Neil Bhardwaj  1 , Giuseppe Garcea  1
Affiliations

Two-Week Wait Gastrointestinal (GI) Cancer Pathway: A Single Tertiary Centre Experience During the COVID-19 Pandemic

Tareq Al Saoudi et al. Cureus. .

Abstract

Background: This article investigated the impact of COVID-19 on the two-week wait referral pathway at the University Hospitals of Leicester NHS Trust. The conversion rate of these referrals was also explored as an indicator of the appropriateness of referrals from primary care.

Methods: Two-week wait referrals to the Cancer Centre of the University Hospitals of Leicester NHS Trust from 2018 to 2020 were collected for upper gastrointestinal (UGI), lower gastrointestinal (LGI), and hepato-pancreato-biliary (HPB) surgery. The confirmed cancer cases out of these referrals were also recorded. Additionally, the outcomes of the multidisciplinary team (MDT) meetings for all patients discussed in June 2018, 2019, and 2020 were collected, and their staging and treatment data were examined.

Results: The number of two-week referrals decreased in 2020 compared to the previous two years across the three specialities. This was more pronounced in April, with a reduction of over 50%. The conversion rate of these referrals increased in 2020 compared to 2018 and 2019 among all three specialities. The increase in conversion rate was statistically significant for LGI referrals (2018 vs 2020 p = 0.0056; 2019 vs 2020 p = 0.0005). There was no significant difference in the MDT outcome across the three specialities.

Conclusion: Two-week wait remains a cornerstone pathway in the management of patients with suspected cancer in the National Health Service. The COVID-19 pandemic appeared to have reduced inappropriate referrals, as evidenced by the increased conversion rate. This did not appear to negatively impact tumour staging and outcomes for those patients who were referred on the pathway.

Keywords: covid-19; general practice; gi cancer; surgical oncology; two week wait pathway.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Two-week referrals and conversion rate for UGI referrals in 2018, 2019, and 2020
UGI: upper gastrointestinal
Figure 2
Figure 2. Two-week referrals and conversion rate for HPB referrals in 2018, 2019, and 2020
HPB: hepato-pancreato-biliary
Figure 3
Figure 3. Two-week referrals and conversion rate for LGI referrals in 2018, 2019, and 2020
LGI: lower gastrointestinal
See this image and copyright information in PMC

References

    1. COVID-19 and cancer: current challenges and perspectives. Bakouny Z, Hawley JE, Choueiri TK, Peters S, Rini BI, Warner JL, Painter CA. https://doi.org/10.1016/j.ccell.2020.09.018. Cancer Cell. 2020;38:629–646. - PMC - PubMed
    1. Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care. Tørring ML, Frydenberg M, Hansen RP, Olesen F, Hamilton W, Vedsted P. Br J Cancer. 2011;104:934–940. - PMC - PubMed
    1. The size of the prize for earlier diagnosis of cancer in England. Richards MA. http://dx.doi.org/10.1038/sj.bjc.6605402 Br J Cancer. 2009;101 Suppl 2:0–9. - PMC - PubMed
    1. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. Sud A, Torr B, Jones ME, et al. Lancet Oncol. 2020;21:1035–1044. - PMC - PubMed
    1. Support MC. The Impact of COVID-19 on cancer care. Macmillan Cancer Support [Internet. 2020. https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/9... https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/9...

LinkOut - more resources