The effects of the Two-Week Rule on NHS colorectal cancer diagnostic services: a systematic literature review.

Kymberley Thorne,Hayley A Hutchings,Glyn Elwyn

doi:10.1186/1472-6963-6-43

Kymberley Thorne, Hayley A Hutchings + Show 1 more

Open Access

https://doi.org/10.1186/1472-6963-6-43

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Abstract

BackgroundThe Two-Week Rule (TWR) was introduced to ensure that all patients with a suspected colorectal cancer (CRC) saw a hospital specialist within 14 days of an urgent GP referral. Guidelines were available to GPs to facilitate the appropriate TWR referral of patients exhibiting high-risk CRC symptoms.MethodsWe aimed to evaluate the TWR and its CRC detection rate on NHS CRC diagnostic services by performing a literature search and critically appraising the peer-reviewed studies. Only 12 studies were eligible for inclusion. Data was collected and overall results were given as weighted averages.ResultsThe studies identified indicated that only 10.3% of patients referred by the TWR were eventually diagnosed with CRC. When examining the referral origin of all CRC patients diagnosed during the time of the studies, 24% had been referred using the TWR, 24.1% were referred as emergency cases, and 52.4% were referred using alternative routes. No evidence was found to indicate that the TWR had resulted in identifying CRC patients at an earlier, more treatable stage of their disease.ConclusionThe TWR referral system needs to be improved to increase the number of CRC patients referred using this fast track method as they present to their GP. The TWR and new NICE Guidelines for the referral of patients with suspected cancer should be independently evaluated.

Highlights

The Two-Week Rule (TWR) was introduced to ensure that all patients with a suspected colorectal cancer (CRC) saw a hospital specialist within 14 days of an urgent GP referral
When determining the referral route of all CRC patients diagnosed during the time of the studies identified, we found that only 24 per cent of CRC patients were referred by GPs using the TWR, [6,7,8,9,10,11,12,13] with a further 24.1 per cent being referred as emergency cases [6,7,8,11,12,13]
The Department of Health (DoH) Guidelines aimed to identify 90 per cent of CRC patients as they presented to their GP, the literature identified by this paper indicated that only 10.3 per cent were eventually diagnosed with CRC

Summary

Introduction

The Two-Week Rule (TWR) was introduced to ensure that all patients with a suspected colorectal cancer (CRC) saw a hospital specialist within 14 days of an urgent GP referral. The Government set targets to be achieved by 2000 for NHS Trusts in England and Wales to see patients with suspected cancer within two weeks of an urgent referral by their GP [1], where "suspected" was defined as either a perceived level of probability or a hunch [2]. This was achieved by the implementation of the Two-Week Rule (TWR) for fast tracking suspected cancer referrals from primary to secondary care [3]. Patients referred using the TWR (page number not for citation purposes)

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