Assessment of a patient consultation questionnaire-based scoring system for stratification of outpatient risk of colorectal cancer.
BACKGROUND
The UK government's fast-track 2-week wait (2WW) rule and colorectal cancer guidelines aimed to detect patients at high risk of having colorectal cancer, but the yield has been poor. A patient consultation questionnaire (PCQ)-based scoring system may be an effective tool for prioritizing colorectal referrals. The aim of this study was to validate the system in a large and ethnically diverse population and to compare it with 2WW referrals.


METHODS
Over a 1-year period, all colorectal referrals (2WW and traditional letters) at nine hospitals in Leicestershire were sent a PCQ to complete and return. A weighted numerical score (WNS), which reflects the patient's risk of having colorectal cancer, was calculated and compared with the hospital diagnosis.


RESULTS
Of a total of 1422 PCQs returned, 83 patients were diagnosed with colorectal cancer. The 2WW referrals constituted 35.7 per cent of all referrals. The mean WNS of patients with colorectal cancer was significantly higher than that of the other patients (mean 76.3 versus 48.9 respectively; P < 0.001). For similar cancer detection rates (or sensitivity), the specificity of a WNS cut-off of 70 was significantly better than that of the 2WW system (82.7 versus 66.1 per cent; P < 0.001).


CONCLUSIONS
The PCQ-based WNS system improves specificity for detecting colorectal cancer, particularly when the WNS exceeds 70.
Rai
S
S
Department of General Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK. sajal.rai@btinternet.com
Ballal
M
M
Thomas
W M
WM
Miller
A S
AS
Jameson
J S
JS
Steward
W P
WP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*