title: How has the 'two-week wait' rule affected the presentation of colorectal cancer?
abstract: OBJECTIVE
  To assess the impact of the 'two-week wait' rule on the presentation of colorectal cancer.
  
  
  METHODS
  A retrospective study of all patients referred to a fast-track clinic in a colorectal cancer centre over an 18-month period, documenting outcome, especially colorectal cancer diagnosis. Comparison was made with patients diagnosed with colorectal cancer presenting via other routes in the same time period.
  
  
  RESULTS
  Over an 18-month period, 462 patients were seen in the fast-track clinic and 64 (13.8%) were diagnosed with colorectal cancer. A further 131 patients with colorectal cancer presented to the department in the same time period through other means; 66 via standard out-patient letters, 26 from other departments and 39 (20%) as emergency admissions. Median (range) time to first clinic was 12 (2-28) days for fast-track and 24 (1-118) days for standard referrals (P < 0.0001); median time to first treatment was a further 36 (9-134) and 36.5 (1-226) days, respectively. The fast-track cohort had more advanced staging than those referred by standard letter. There were 19 Dukes' B, 22 Dukes' C and 14 Dukes' D cancers in the fast-track group compared with 28 Dukes' B, 25 Dukes' C and 6 Dukes' D in the standard referral group. After patient interview, only 337 (73%) of 462 fast-track patients appeared to fulfil the referral criteria but of the 64 diagnosed with cancer, 59 (92%) satisfied the criteria. Of the 66 patients with cancer referred by standard letter, 61 (92%) fulfilled the criteria.
  
  
  CONCLUSIONS
  Patients referred to the fast-track clinic were seen quicker than those referred by standard letter, but they tended to have more advanced disease. The fast-track referral criteria were fulfilled by most patients with cancer (whether or not they were referred to the fast track clinic), confirming their validity. After detailed interview in the clinic, a quarter of fast-track referrals were found not to satisfy referral criteria, suggesting that prioritization in primary care could be improved.
authors.affiliation: Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: D P K
authors.initials: DP
authors.lastname: Chohan
authors.forename: K
authors.initials: K
authors.lastname: Goodwin
authors.forename: S
authors.initials: S
authors.lastname: Wilkinson
authors.forename: R
authors.initials: R
authors.lastname: Miller
authors.forename: N R
authors.initials: NR
authors.lastname: Hall
mesh_terms: D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D006113:United Kingdom