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Upper gastrointestinal cancer: Do our clinical services work towards the 'two week rule' and how? / Serban Ioan Gheorghiu

Swansea University Author: Serban Ioan, Gheorghiu

Abstract

The present research w ork investigates the results observed in the management o f those patients diagnosed w ith Upper Gastro-Intestinal Cancers subsequent to the use o f algorithm s o f referral and clinical services such as Open Access Endoscopy and Rapid Opinion Clinic. This is a retrospective a...

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Published: 2006
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
URI: https://cronfa.swan.ac.uk/Record/cronfa43006
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Abstract: The present research w ork investigates the results observed in the management o f those patients diagnosed w ith Upper Gastro-Intestinal Cancers subsequent to the use o f algorithm s o f referral and clinical services such as Open Access Endoscopy and Rapid Opinion Clinic. This is a retrospective analysis based on the auditing methodology which looks to the experience gained in two NHS Trust hospitals in South W ales over a period o f six calendar years.A n uncensored cohort o f 440 patients diagnosed w ith various forms o f Upper Gastro-Intestinal cancers are examined and their referral pathway, positive diagnosis, investigation and staging, as well as treatm ent and 5-year follow up is analyzed. The traditional m ethods o f referring patients from the Primary Care sector are compared w ith the new open-access type o f clinical services such as Open Access Endoscopy and Rapid Opinion Clinic in the context o f the "two week rule" for cancer referral. It has been found that using the open access services the median delay for appointments is reduced to 11 days which is below the required threshold imposed by The NHS Cancer Plan. The mean GP delay interval remains slightly higher at 17.09 days mainly due to cases w ith atypical clinical picture; the same applies to the mean treatm ent delay which at 44.43 days is related w ith the staging investigations.The results o f these referral m ethods are also discussed from the perspective o f patients' outcome as a measure o f the benefits gained through the introduction o f these clinical services. It has been noted that the rate o f newly diagnosed early stage cancers has not increased and there was no gained benefit in diagnosing patients w ith more favourable stage o f the disease. There was a hint that patients diagnosed through Open Access Endoscopy may have a less advanced disease with a higher rate o f operability and a sm aller benefit in survival probability.This study concludes that new open-access style clinical services backed up by clear referral algorithm s may increase the speed o f patients' appointments and diagnosis in the Secondary Care sector but there is only little clinical and statistical evidence o f benefits such as early cancer detection, operability and survival probability.Areas o f improvement in referral algorithm such as the com bination o f "alarm symptoms", exclusion o f uncomplicated dyspepsia as a referral criterion in young adults, pooling all patients at risk w ith gastroenterological symptoms under the open access style o f referral and stream lining o f the staging and treatm ent pathway are amongst recommendations made at the end o f this study.
Keywords: Gastrointestinal cancer, malignancy, clinical services
College: Swansea University Medical School