Abstract
BackgroundThe aim of this study is to determine whether the ‘Fast-Track’ referral system has changed the route by which patients present with colorectal cancer (CRC) and whether the route of presentation has any effect on clinical outcome.MethodsA retrospective cohort study of patients diagnosed with CRC under the care of two consultant colorectal surgeons between April 2006 and December 2012. The route by which patients presented was categorised as Fast-Track (FT), non-Fast-Track (non-FT) or acute. Outcome variables were operative intent, disease stage and 2- and 5-year survival.ResultsA total of 558 patients were identified. One hundred ninety-seven patients (35.3 %) were referred as FT, 108 (19.4 %) presented acutely and 253 patients (45.3 %) presented via other routes (non-FT). Over the study period, the route of presentation did not change significantly (P = 0.135). There was no significant difference between FT and non-FT groups in terms of the proportion of patients undergoing potentially curative surgery (70.6 vs 74.3 %, P = 0.092) or with node-negative disease (48.2 vs 52.2 %, P = 0.796) nor was there any difference in 2-year or 5-year survival (74.1 vs 73.9 %, P = 0.837 and 52.3 vs 53.8 %, P = 0.889, respectively). Patients who presented acutely were less likely to undergo curative resection, had more advanced disease and had worse 2- and 5-year survival.ConclusionsThe Fast-Track referral system has not affected the route by which patients present with CRC nor has it had any effect on clinical outcomes. Alternative strategies are required if the desired improvement in outcomes is to be achieved.
Highlights
The aim of this study is to determine whether the ‘Fast-Track’ referral system has changed the route by which patients present with colorectal cancer (CRC) and whether the route of presentation has any effect on clinical outcome
The aims of this study were to (1) determine whether the Fast-Track system has changed the route by which patients present with CRC and (2) assess whether the route of presentation has any effect on outcomes, in terms of treatment intent, disease stage or survival
The relatively small number of patients diagnosed through the National Bowel Cancer Screening Programme is explained by the fact that it commenced in York only in February 2010
Summary
The aim of this study is to determine whether the ‘Fast-Track’ referral system has changed the route by which patients present with colorectal cancer (CRC) and whether the route of presentation has any effect on clinical outcome. The current 5-year survival in the UK is 54.4 % in men and 55.1 % in women, but as high as 90 % if diagnosed at its earliest stage (Dukes’ A) [4] This compares unfavourably with elsewhere in Europe, where survival rates are 8–12 %. In 2000, the UK Department of Health introduced the ‘Fast-Track’ or ‘Two Week Wait’ system for patients with suspected cancer [7], in an attempt to address some of these issues. This system applies to all the common cancers, including CRC. Patients referred in this way Thornton et al World Journal of Surgical Oncology (2016) 14:158
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