Abstract
Urgent GP cancer referrals, often referred to as 2-week wait (2WW) referrals in England (with equivalent processes in the devolved nations), have changed the landscape of cancer diagnosis in the UK. The data presented by Round et al ,1 demonstrate this starkly: referrals have increased hugely over the past decade and the detection rate (DR; the percentage of new cancer cases treated resulting from a 2WW referral) has increased from 41% to 52% over this period. This is especially good news as patients whose cancer is diagnosed after a 2WW referral are more likely to have earlier stage disease, and therefore have better outcomes, than those diagnosed through other routes. Indeed, Round et al estimate that if DRs hadn’t increased, then 165 899 fewer cancers would have been diagnosed through this pathway over the past decade in England, and many of these would subsequently have had more advanced stage disease, less well tolerated treatments, and poorer outcomes as a result. One of the downsides of the increase in 2WW referrals is that conversion rates (the percentage of 2WW referrals resulting in a cancer diagnosis) have fallen, meaning that the 2WW referral system is becoming less efficient, and many more patients are being referred who do not have cancer. These outcomes are all a predictable consequence of the liberalising of risk thresholds underpinning the referral guidance by the National Institute for Health and Care Excellence (NICE) in 2015. The study also highlighted significant variation between practices, and identified factors that might contribute to the variation in detection rate (larger practices, younger GPs, and more deprived populations). While these may not be amenable to intervention, reasons for these associations need exploring further. The study raises important questions that we …
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More From: The British journal of general practice : the journal of the Royal College of General Practitioners
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