Two Week Rule Compliance: Assessing General Practice Use of the 'Two Week Rule' Referral Pathway for the Suspicion of Colorectal Cancer

Khan Khurram Shahzad,Saldanha James,Grayston Alexander,Denley Simon,Mukherjee Arijit

doi:10.36959/856/516

Abstract

The 'Two-Week-Rule' (TWR) for referring patients with a suspicion of colorectal cancer (CRC) was implemented in 2000 to improve CRC survival rates. Guidelines exist to assist general practitioners (GPs) identify patients based on high-risk symptomology. Our aim was to evaluate the effectiveness of these guidelines, to determine whether a correlation exists between individual criteria within the guidelines and CRC, and to assess GP compliance of guidelines in referring symptomatic patients.

Highlights

Colorectal cancer (CRC) is a significant and increasing health problem in the western world
Of the 485 patients referred as TWR, 19 (3.9%) were excluded. 320 (68.7%) referrals complied with National Institute for Health Care and Excellence (NICE) guidelines and additional 146 referrals (31.3%) were non-compliant with NICE guidelines
colorectal cancer (CRC) or high grade dysplasia (HGD) was diagnosed in 6.0% (n = 28, 24 and 4 respectively) of referrals; 27 of which (96.4%, p = 0.0005) were identified following a guideline compliant referral

Summary

Introduction

Colorectal cancer (CRC) is a significant and increasing health problem in the western world. In 2012, 42,000 new cases of CRC were diagnosed in the UK, a rate of almost 115 cases per day [1]. It has long been accepted that early diagnosis and treatment improves the chances of survival [2]; yet to date, many patients still present with advanced stages of the disease and only 60% of new diagnoses have a five-year survival rate [3]. The ‘Two-Week-Rule’ (TWR) for referring patients with a suspicion of colorectal cancer (CRC) was implemented in 2000 to improve CRC survival rates. Our aim was to evaluate the effectiveness of these guidelines, to determine whether a correlation exists between individual criteria within the guidelines and CRC, and to assess GP compliance of guidelines in referring symptomatic patients

Objectives

Methods

Results

Discussion

Conclusion