Fast Tracking Suspected Colorectal Cancer Patients – Is It Time to Reflect Our Current Practice?

Introduction
Early detection of colorectal cancer (CRC) can improve survival rate. To aid fast tracking suspected CRC referrals from primary to secondary care, National Institute of Clinical Excellence (NICE) guidelines (2005)^ were published in UK for these patients to be referred and seen in a secondary care centre within two weeks (TWR). However, not every patient diagnosed with CRC comes via the TWR. The use of these guidelines by the referral sources and the adequacy of the referral criteria were analyzed as part of the study.

Methods
All patients diagnosed with CRC between 2004 and 2006 were retrospectively analysed to assess the number of missed TWR referrals. Patient demographics, presenting signs, symptoms and investigations were assessed. Statistical analysis was done using SPSS.

Results
43 patients diagnosed with CRC were not referred as TWR and a significant number of these patients presented with alternate symptoms. Mean age was 71 years (range 49–85 years) with similar gender distribution (p>0.05). 30 patients (70 %) were referred via routine GP referral whereas 9 (21 %) patients were referred as urgent but not as TWR. 4 (9%) patients were sent directly for endoscopy. Presenting symptoms included iron deficiency anaemia in 11 patients (25.6 %), rectal bleeding [10 patients (23.3 %)], diarrhoea >6 weeks [8 patients (18.6 %)], rectal bleeding with chronic diarrhoea [5 patients (11.6 %)] and a palpable mass in 2 patients (4.6 %)]. 32 patients (74%) had at least one criteria and 4 patients (9.3%) met more then one referral criteria for the TWR. Review of symptoms showed 11 out of 43 patients (26 %) did not meet NICE referral criteria (p


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