Diagnostic Accuracy amongst Two Week Wait Referrals for Skin Malignancy

Haile-Redai Ayda,O'Connor Johanna

doi:10.23937/2469-5750/1510111

Haile-Redai Ayda, O'Connor Johanna

Open Access

https://doi.org/10.23937/2469-5750/1510111

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Abstract

The two week wait pathway initiative was proposed in 1997 to expedite referrals from general practice to dermatology and to facilitate access to timely treatment for patients with suspected skin malignancy. However, since its implementation it has come under fire for its poor specificity and case detection rate with dermatologists raising concerns about their increased workload and consequently lack of time for other urgent cases.

Highlights

The two-week wait pathway was first introduced in the U.K in 1997, in a bid to expedite the referral of suspected cancer patients from primary care to specialists and improving survival
The present study conducted at Queen’s Hospital, London aimed to assess (i) The proportion of referred patients seen within two weeks and treated within 62 days (ii) The proportion of patients referred for suspected malignancies that were subsequently confirmed and (iii) What benign skin lesions were most commonly referred to dermatology
The results show that two-week wait referrals for suspected skin cancer from general practitioners (GPs)’s have a low diagnostic accuracy and this may be contributing to delayed patient care within the hospital setting

Summary

Introduction

The two-week wait pathway was first introduced in the U.K in 1997, in a bid to expedite the referral of suspected cancer patients from primary care to specialists and improving survival. This was thought to help alleviate psychological distress associated with diagnostic uncertainty in patients. Under this initiative, the NHS cancer referral timeline stipulates that general practitioners (GPs) are to refer patients to specialists via a standardised faxed proforma within 24 hours of the consultation, following which consultations with specialists are to take place within 2 weeks of referral and treatment is to commence within 62 days [1]. Since 2015, NHS guidelines recommend that suspected melanoma cases should be referred via the two-week wait pathway if they score greater than 3 on the weighted seven point checklist (Figure 2) [5]

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