Since last year, Britain’s National Health Service has been working to reduce its long waiting lists so that patients with suspected cancer would be seen by a specialist within two weeks of referral by their general practitioner. How is it working?
Not too well, say some physicians. Although there have been substantial reductions in delays for patients with suspicious symptoms as defined by NHS guidelines, several abstracts presented to the British Society of Gastroenterology suggest that the two-week standard is being met at the expense of a substantial increase in waiting time for routine referrals, while not necessarily identifying treatable cases of cancer.
The predictive value for colorectal cancer of persistent rectal bleeding and change in bowel habit, for example, is about 30 percent but significant numbers of patients with lower risk symptoms will nevertheless prove to have cancer and may now experience longer waiting times than before.
Paradoxically, those not immediately referred might harbour malignancy at an earlier stage, with better prospects of cure. Further research is needed to determine whether the initiative to shorten waiting lists reduces Britain’s high cancer mortality rates or make matters worse.
Source: Roger Jones, Greg Rubin and Pali Hungin, Is the two week rule for cancer referrals working? Not too well, Editorial, British Medical Journal, June 30, 2001.
For text http://bmj.com/cgi/content/full/322/7302/1555
For more on National Health http://www.ncpa.org/pi/health/hedex10d.html
FMF\10 July 2001
