Fast-track Referral Research Articles

Pathways to cancer diagnosis: current state and recommendations.

Diagnosing cancer early is crucial in improving patient outcomes. Primary care networks are encouraged to audit routes to cancer diagnosis, as suggested by the Network Contract Directed Enhanced Service Early Cancer Diagnosis Guidance. We aim to measure how many patients were diagnosed with cancer in the period of April 2021 to March 2022 at an Essex GP practice, and for each of those patients, to ascertain the route of their diagnosis. We also conducted learning event analyses for patients whose diagnoses were not detected through 2-week wait (2WW) or screening. SystmOne Read codes were utilised to identify all patients coded with 'cancer', and 'fast-track cancer referral'. We measured the conversion rate of 2WW referrals to cancer diagnoses. For diagnoses not detected via 2WW or screening, we analysed patient notes for previous consultations and eventual route to diagnosis. In total, 160 2WW referrals were made with a 6.25% conversion rate to cancer diagnoses. In total, 26 patients were diagnosed with cancer. Seventeen patients were diagnosed through 2WW, three through national screening programmes, three through accident and emergency, two through routine referral, and one through incidental finding. For the six patients not diagnosed through 2WW or screening, reasons why included poor patient engagement with healthcare services, referrals requiring chasing, patients passed between specialties, and failure to detect pertinent clinical signs. It is promising that the majority of cancers are diagnosed through 2WW and screening; however, improving patient engagement, streamlining referrals, and thorough clinical examination and documentation will reduce delayed or missed diagnoses.

Neck lumps

Neck lumps are a common presenting complaint in primary care. They can cause a significant amount of concern for patients, due to their visibility around the head and neck. There is a plethora of causes for lumps in the neck, some of which need to be investigated urgently. In this article, we suggest a method for identifying the likely cause of a neck lump, introduce possible management strategies and cover red flag signs and symptoms to prompt urgent onward referral for investigation. The differential diagnosis of a lump in the neck may seem intimidating, but a thorough, systematic approach to history and examination narrows this list and directs appropriate investigation. If malignancy is suspected, a 2-week fast track referral should be made, without waiting for results of investigations in the community. These may be requested simultaneously with referral, according to local policy.

Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England

Mental health morbidity (MHM) in patients presenting with possible cancer symptoms may be associated with prediagnostic care and time to cancer diagnosis. To compare the length of intervals to cancer diagnosis by preexisting MHM status in patients who presented with symptoms of as-yet-undiagnosed colon cancer and evaluate their risk of emergency cancer diagnosis. This cohort study was conducted using linked primary care data obtained from the population-based Clinical Practice Research Datalink, which includes primary care practices in England, linked to cancer registry and hospital data. Included participants were 3766 patients diagnosed with colon cancer between 2011 and 2015 presenting with cancer-relevant symptoms up to 24 months before their diagnosis. Data analysis was performed in January 2021 to April 2022. Mental health conditions recorded in primary care before cancer diagnosis, including anxiety, depression, schizophrenia, bipolar disorder, alcohol addiction, anorexia, and bulimia. Fast-track (also termed 2-week wait) specialist referral for investigations, time to colonoscopy and cancer diagnosis, and risk of emergency cancer diagnosis. Among 3766 patients with colon cancer (median [IQR] age, 75 [65-82] years; 1911 [50.7%] women ), 623 patients [16.5%] had preexisting MHM recorded in primary care the year before cancer diagnosis, including 562 patients (14.9%) with preexisting anxiety or depression (accounting for 90.2% of patients with preexisting MHM) and 61 patients (1.6%) with other MHM; 3143 patients (83.5%) did not have MHM. Patients with MHM had records of red-flag symptoms or signs (ie, rectal bleeding, change in bowel habit, or anemia) in the 24 months before cancer diagnosis in a smaller proportion compared with patients without MHM (308 patients [49.4%] vs 1807 patients [57.5%]; P < .001). Even when red-flag symptoms were recorded, patients with MHM had lower odds of fast-track specialist referral (adjusted odds ratio [OR] = 0.72; 95% CI, 0.55-0.94; P = .01). Among 2115 patients with red-flag symptoms or signs, 308 patients with MHM experienced a more than 2-fold longer median (IQR) time to cancer diagnosis (326 [75-552] days vs 133 [47-422] days) and higher odds of emergency diagnosis (90 patients [29.2%] vs 327 patients [18.1%]; adjusted OR = 1.63; 95% CI, 1.23-2.24; P < .001) compared with 1807 patients without MHM. This study found that patients with MHM experienced large and prognostically consequential disparities in diagnostic care before a colon cancer diagnosis. These findings suggest that appropriate pathways and follow-up strategies after symptomatic presentation are needed for earlier cancer diagnoses and improved health outcomes in this large patient group.

The Role of the Multidisciplinary Health Care Team in the Management of Patients with Systemic Sclerosis.

Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vascular damage and fibrosis affecting the skin and multiple internal organs. The clinical spectrum of SSc is wide and its manifestations may lead to severe morbidity and mortality, in addition to a great impact on patients’ quality of life. Due to the multifaceted clinical manifestations of SSc, its management requires a combined expertise of different medical specialists to guarantee an adequate disease control and prevent organ complications. Multi-disciplinary teams (MDT), which are composed by physicians and other specialized health professionals, represent therefore a key element for the comprehensive management of SSc patients. Moreover, MTD can improve communication and patients’ empowerment while the presence of dedicated nurses can help patients to ask questions about their condition. The scope of this narrative review is to analyse the available evidences regarding the role of MDT in the management of SSc patients, and how this holistic approach may improve different disease domains and the overall prognosis. MDT regarding the cardiovascular and lung complication are the more represented in literature, given the great impact in prognosis. Nonetheless, MDT have been shown to be fundamental also in other disease domains as they can intercept early manifestations, thus stratifying patients based on the individual risks in order to personalize patients’ follow-up. MDTs may also minimize the treatment delay, enabling fast-track specialist referral. On the other hand, there are few trials specifically studying MDT in SSc and several authors have highlight the lack of standardization.

Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW)

IntroductionLow birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is...

Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study.

Simple SummaryIn England, patients with alarm features of cancer should be assessed by a specialist within 14 days based on national guidelines. However, it is not known how quickly these patients are actually diagnosed. We therefore examined how quickly patients who met these fast-track referral criteria were actually diagnosed, using bladder and kidney cancer patients as exemplars. We found that of the patients who qualified for fast-track referral, more than one-quarter did not receive a timely diagnosis. Those with recurrent urinary tract infections, of female sex and in the extremes of age, were most likely to have a non-timely diagnosis. Our findings suggest that opportunities exist to improve timely referral in patients with bladder and kidney cancer.Background: In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. We examined how quickly bladder and kidney cancer patients who met fast-track referral criteria were actually diagnosed. Methods: We used linked primary care and cancer registration data on bladder and kidney cancer patients who met fast-track referral criteria and examined the time from their first presentation with alarm features to diagnosis. Using logistic regression we examined factors most likely to be associated with non-timely diagnosis (defined as intervals exceeding 90 days), adjusting for age, sex and cancer type, positing that such occurrences represent missed opportunity for timely referral, possibly due to sub-optimal guideline adherence. Results: 28%, 42% and 31% of all urological cancer patients reported no, one or two or more relevant symptoms respectively in the year before diagnosis. Of the 2105 patients with alarm features warranting fast-track assessment, 1373 (65%) presented with unexplained haematuria, 382 (18%) with recurrent urinary tract infections (UTIs), 303 (14%) with visible haematuria, and 45 (2%) with an abdominal mass. 27% overall, and 24%, 45%, 18% and 27% of each group respectively, had a non-timely diagnosis. Presentation with recurrent UTI was associated with longest median diagnostic interval (median 83 days, IQR 43–151) and visible haematuria with the shortest (median 50 days, IQR 30–79). After adjustment, presentation with recurrent UTIs, being in the youngest or oldest age group, female sex, and diagnosis of kidney and upper tract urothelial cancer, were associated with greater odds of non-timely diagnosis. Conclusion: More than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients. The findings highlight a substantial number of opportunities for expediting the diagnosis of patients with bladder or kidney cancers.

Contribution of primary care organisation and specialist care provider to variation in GP referrals for suspected cancer: ecological analysis of national data

ObjectivesTo examine how much of the variation between general practices in referral rates and cancer detection rates is attributable to local health services rather than the practices or their populations.DesignEcological...

Initiation of physical activity prehabiliation and rehabilitation for major colorectal surgery

Objectives: Physical activity can reduce complications from1 and enhance recovery following2 colorectal surgery. We aimed to introduce a community based prehabilitation and rehabilitation program via a fast-track referral into an existing service in our locality: The Physical Activity Referral in Stockport (PARiS) scheme.

Dedicated under 35 breast clinic: is this the answer?

Introduction: Approximately 50,000 new breast cancers are diagnosed each year in the UK. The incidence of new breast cancer rises with age with 62 women diagnosed per 100,000 each year under 40 (1277 cases approximately each year). The updated NICE guidelines advice urgent fast-track referral for all patients presenting with a breast or an axillary lump (with or without pain) aged over 30 years to be seen within 2 weeks.

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

Background: Fast-track referral is an increasingly used method for diagnostic evaluation of patients suspected of having cancer. This approach is challenging and not used as often for patients with only nonspecific symptoms. In order to expedite the diagnostics for these patients, we established Sweden’s first Diagnostic Center (DC) focusing on outcomes related to diagnoses and diagnostic time intervals.Material and Methods: The study was designed as a prospective cohort study. Patients aged ≥18 years who presented in primary care with nonspecific symptoms of a serious disease were eligible for referral to the DC after having completed an initial investigation. Acceptable diagnostic time intervals were defined to be a maximum of 15 days in primary care and 22 days at the DC. Diagnostic outcome, length of diagnostic time intervals and patient satisfaction were evaluated.Results: A total of 290 patients were included in the study. Cancer was diagnosed in 22.1%, other diseases in 64.1%, and no diagnosis was identified in 13.8% of these patients. Patients diagnosed with cancer were older, had shorter patient interval (time from first symptom to help-seeking), shorter DC-interval (time from referral decision in primary care to diagnosis) and showed a greater number of symptoms compared to patients with no diagnosis. The median primary care interval was 21 days and the median DC interval was 11 days. Few symptoms, no diagnosis, female sex, longer patient interval, and incomplete investigations were associated with prolonged diagnostic time intervals. Patient satisfaction was high; 86% of patients reported a positive degree of satisfaction with the diagnostic procedures.Conclusions: We demonstrated that the DC concept is feasible with a diagnosis reached in 86.2% of the patients in addition to favorable diagnostic time intervals at the DC and a high degree of patient satisfaction.Trial registration: ClinicalTrials.gov identifier: NCT01709539.

566. Earlier Linkage and ART Initiation Via Fast Track Referral System for New HIV Patients Leads to Stronger Engagement and Better Outcomes

BackgroundTo reach the 90-90-90 target goals for HIV care, clinical service requires a coordinated strategy to overcome barriers that prevent patients’ sustained wellbeing. Earlier initiation of antiretroviral therapy (ART) improves desired outcomes yet it can be a difficult task. With the help the Early Intervention Service (EIS) from our local Health Department in Connecticut, our academic clinic implemented a Fast-Track Linkage (FTL) and ART process for clients new to HIV care by providing services within 10 days of diagnosis. The aim of our study was to compare this new system with the standard of care (SOC).MethodsWe retrospectively reviewed the medical records of all new patients who were referred for HIV care at this single academic center from 2014 to 2016. Only patients not on ART at the initial visit were included. We divided them into two groups. One with patients that were newly diagnosed and utilized the FTL vs. all others. We compared the demographic and outcome data including retention in care, viral suppression (VS) and CD4 differences.ResultsForty-seven were referred via the FTL system (see Table 1). Our analysis did not identify any significant barrier to care. FTL patients were significantly younger. Retention, ART, VS and CD4 recovery were better in the group that was treated earlier.Table 1: SOC FTL P N 2947Age (median [IQR])50.00 [42.00, 55.00]31.00 [26.50, 39.50]<0.001Sex (%)0.367Female6 (20.7)5 (10.6)Male23 (79.3)41 (87.2)Race (%)0.583Asian/Pacific Islander0 (0.0)1 (2.1)Black, non-Hispanic17 (58.6)23 (48.9)Hispanic4 (13.8)6 (12.8)White, Hispanic1 (3.4)0 (0.0)Other0 (0.0)1 (2.1)White, non-Hispanic7 (24.1)16 (34.0)HIV risk group (%)0.011Heterosexual sex9 (31.0)12 (25.5)Injection drug use6 (20.7)1 (2.1)Men who have sex with men12 (41.4)34 (72.3)Time to first HIV clinic visit (median [IQR])N/A9.00 [0.00, 19.00]0.016Retained in care (≥2 visits in >90 days) (%)22 (75.9)43 (91.5)0.122Prescribed antiretroviral therapy (%)18 (62.1)43 (91.5)0.005HIV viral suppression at 1 year (%)20 (69.0)37 (78.7)0.495Initial CD4 counts at baseline (ave)3404140.334CD4 count change at d365+53+2300.004ConclusionImplementation of FTL systems that include EIS can lead to successful and sustained high rates of VS and improved CD4 recovery. Larger scale initiatives could prove to be highly beneficial from a public health perspective.Disclosures All authors: No reported disclosures.

Variation in 'Fast-Track' Referrals for Suspected Cancer by Patient Characteristic and Cancer Diagnosis: Evidence From 670,000 Patients With Cancers of 35 Different Sites

Background: In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. Methods: We examined data from 669,220 patients with 35 cancers diagnosed 2006-2010 following either fast-track or nonfast track primary-to-secondary care referrals using a bespoke English dataset, the 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristics and cancer diagnosis and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. Results: There were large variations in the odds of fast-track referral by cancer ( P &lt; 0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35 respectively, using rectal cancer as reference); while patients with brain cancer and leukemias least likely (adjusted odds ratios 0.05 and 0.09 respectively for brain cancer and acute myeloid leukemia). There were sex, age and deprivation differences in the odds of fast-track referral ( P &lt; 0.013), which varied in their size and direction for patients with different cancers ( P &lt; 0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. Conclusion: Fast-track referrals are less likely for cancers characterized by nonspecific presenting symptoms and patients belonging to low incidence demographic strata. Interventions beyond clinical guidelines for “alarm” symptoms are needed to improve diagnostic timeliness.

Variation in \u2018fast-track\u2019 referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670\u2009000 patients with cancers of 35 different sites

Background:In England, ‘fast-track’ (also known as ‘two-week wait’) general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups.Methods:We examined data from 669 220 patients with 35 cancers diagnosed in 2006–2010 following either fast-track or ‘routine’ primary-to-secondary care referrals using ‘Routes to Diagnosis’ data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer.Results:There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer.Conclusions:Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for ‘alarm’ symptoms are needed to improve diagnostic timeliness.

A Fast-Track Referral System for Skin Lesions Suspicious of Melanoma: Population-Based Cross-Sectional Study from a Plastic Surgery Center.

Introduction. To minimize delay between presentation, diagnosis, and treatment of cutaneous melanoma (CM), a national fast-track referral system (FTRS) was implemented in Denmark. The aim of this study was to analyze the referral patterns to our department of skin lesions suspicious of melanoma in the FTRS. Methods. Patients referred to the Department of Plastic Surgery and Breast Surgery in Zealand University Hospital were registered prospectively over a 1-year period in 2014. A cross-sectional study was performed analyzing referral patterns, including patient and tumor characteristics. Results. A total of 556 patients were registered as referred to the center in the FTRS for skin lesions suspicious of melanoma. Among these, a total of 312 patients (56.1%) were diagnosed with CM. Additionally, 41 (7.4%) of the referred patients were diagnosed with in situ melanoma. Conclusion. In total, 353 (63.5%) patients had a malignant or premalignant melanocytic skin lesion. When only considering patients who where referred without a biopsy, the diagnostic accuracy for GPs and dermatologists was 29% and 45%, respectively. We suggest that efforts of adequate training for the referring physicians in diagnosing melanocytic skin lesions will increase diagnostic accuracy, leading to larger capacity in secondary care for the required treatment of malignant skin lesions.

Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom.

PurposeTo validate the recorded diagnoses of colorectal cancer (CRC) and identify false negatives in The Health Improvement Network (THIN) primary care database.MethodsWe conducted a validation study of incident CRC cases in THIN among patients aged 40–89 years from 2000–2011. CRC Read code entries (N = 3805) were verified by manual review of patients' electronic medical records (EMRs) including free‐text comments. Incident CRC cases in THIN ascertained following manual review were validated against two data sources deemed gold standards: (i) questionnaires sent to primary care practitioners (PCPs; for a random sample of 100 potential CRC cases), and (ii) Hospital Episode Statistics (HES) among linked practices. False negatives in THIN were identified by searching for International Classification of Diseases‐10 codes related to CRC in HES.ResultsOf 3805 CRC cases identified in THIN via Read codes, 3033 patients (80.0%) were considered definite cases after manual review of EMRs. The positive predictive value (PPV) of CRC Read codes was 86.0% after removing patients identified from THIN via a Read code for ‘fast track referral for suspected CRC’. The response rate from PCPs was 87.0% (n = 87), and the PPV of CRC in THIN was 100% based on PCP questionnaires. Using HES, the PPV for CRC in THIN was 97.9% (556/568), and false negative rate was 6.1% (36/592).ConclusionsCRC diagnostic Read codes in THIN have a high PPV, which is increased further following manual review of free‐text comments. The false negative rate of CRC diagnoses in THIN is low. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Uterine artery embolisation for obstetric hemorrhages treatment

Introduction. The major causes of death in women of reproductive age are pregnancy and perinatal complications. According to the WHO data, postpartum haemorrhage (PPH) occurs in about 10.5% of deliveries worldwide and is the leading single cause of mortality amongs young women (estimated at about 25% of deaths). PPH is diagnosed as blood loss > 500 ml during vaginal delivery. Haemorrhages can be effectively treated avoiding surgical interventions by uterine artery embolisation (UAE). Aim. Assessment of efficacy and outcomes of percutaneous uterine artery embolisation for the treatment of postpartum haemorrhage and assessment the validity of prophylactic catheter balloons arteries leaving in the internal iliac artery. Material and methods. In the years 2011-2014, 12 uterine artery embolisation procedures were carried out in the Department of Interventional Radiology and Neuroradiology MU Lublin. The embolisation procedures were performed using gelatin foam or Embozene calibrated particles. The technical success was lack of contrast blood inflow into the uterine arteries. Results. In 5 cases embolisation were performed using standard catheters and gelatin foam; in 7 cases microcatheters and spherical, calibrated Embozene particles, 500 and 700 um in diameter, had to be used. In the 11 patients, the embolisation procedures effectively stopped bleedings. In one patient, hysterectomy was performed several hours after embolisation due to further bleeding. Clinical efficacy was found to be 91%. Conclusions. The procedure of percutaneous uterine artery embolisation seems to be an effective and safe method for the treatment of postpartum haemorrhage. The key to success is cooperation of gynaecologists and interventional radiologists and developed fast-track referral of patients. In some cases prophylactic artery catheterization balloon leaving in the internal iliac artery is also recommended.

A survey of current and anticipated use of standard and specialist equipment by UK optometrists.

To investigate current and anticipated use of equipment and information technology (IT) in community optometric practice in the UK, and to elicit optometrists' views on adoption of specialist equipment and IT. An anonymous online questionnaire was developed, covering use of standard and specialist diagnostic equipment, and IT. The survey was distributed to a random sample of 1300 UK College of Optometrists members. Four hundred and thirty-two responses were received (response rate=35%). Enhanced (locally commissioned) or additional/separately contracted services were provided by 73% of respondents. Services included glaucoma repeat measures (30% of respondents), glaucoma referral refinement (22%), fast-track referral for wet age-related macular degeneration (48%), and direct cataract referral (40%). Most respondents (88%) reported using non-contact/pneumo tonometry for intra-ocular pressure measurement, with 81% using Goldmann or Perkins tonometry. The most widely used item of specialist equipment was the fundus camera (74% of respondents). Optical Coherence Tomography (OCT) was used by 15% of respondents, up from 2% in 2007. Notably, 43% of those anticipating purchasing specialist equipment in the next 12months planned to buy an OCT. 'Paperless' records were used by 39% of respondents, and almost 80% of practices used an electronic patient record/practice management system. Variations in responses between parts of the UK reflect differences in the provision of the General Ophthalmic Services contract or community enhanced services. There was general agreement that specialised equipment enhances clinical care, permits increased involvement in enhanced services, promotes the practice and can be used as a defence in clinico-legal cases, but initial costs and ongoing maintenance can be a financial burden. Respondents generally agreed that IT facilitates administrative flow and secure exchange of health information, and promotes a state-of-the-art practice image. However, use of IT may not save examination time; its dynamic nature necessitates frequent updates and technical support; the need for adequate training is an issue; and security of data is also a concern. UK optometrists increasingly employ modern equipment and IT services to enhance patient care and for practice management. While the clinical benefits of specialist equipment and IT are appreciated, questions remain as to whether the investment is cost-effective, and how specialist equipment and IT may be used to best advantage in community optometric practice.

P57 Fast track referral of patients with malignant mesothelioma is not associated with better survival

BackgroundFew studies have examined the effect on survival in lung cancer of fast-track referral, while those that do have questioned the utility of the two-week fast track referral rule 1....

PTH-131 First Year Results from a Virtual Iron Deficiency Anaemia Service at a District General Hospital

IntroductionIron deficiency anaemia (IDA) has a prevalence of up to 5% in adult men and post-menopausal women, and is a common cause of referral to gastroenterologists. Important and common causes...

The association between referral source and outcome in patients with colorectal cancer

AimThe colorectal two-week wait fast track (FT) referral system was nationally implemented in the UK in 2000 to ensure patients with colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to determine the association between the mechanism of referral to colorectal services and the 5-year outcomes for patients with CRC. MethodsConsecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively. Analysis for survival and recurrence of disease at 5 years from presentation was undertaken. Outcomes for patients were compared between fast track (FT), non-fast track (NFT) and emergency referral (ER) routes, using Kaplan–Meier survival estimates. ResultsOut of 189 patients, 96 (51%) presented via the FT, 41 (22.5%) via the NFT and 52 (27.5%) via the ER referral route. The 5-year overall survival was 52.6% ± 5.1, 41.5% ± 7.7 and 38.5% ± 6.7 for the FT-, NFT- and ER groups respectively (p = 0.075). The 5-year cancer specific survival was 60.3% ± 5.2, 58.8% ± 5.3 and 43.5% ± 7.2 for the FT-, NFT- and ER groups respectively (p = 0.056). Patients referred as emergencies had worse 5-year overall survival; 49.3% ± 4.3 (FT&NFT) vs. 38.5% ± 6.7 (ER) (p = 0.042) and 5-year cancer specific survival 59.8% ± 4.4 (FT&NFT) vs. 43.5% ± 7.2 (ER) (p = 0.016). A total of 136 patients (FT n = 71, NFT n = 34, ER n = 31) underwent potentially curative surgery. Differences in 5-year survival did not reach statistical significance in these patients. ConclusionReferral route to specialist services for patients with CRC via the fast track pathway compared to non-fast track pathway was not associated with improved survival.