title: Can the National Health Service Cancer Plan timeline be applied to colorectal hepatic metastases?
abstract: BACKGROUND
  The National Health Service (NHS) Cancer Plan guidelines recommend a maximum 2-week wait from referral to first appointment, and 2 months from referral to treatment for primary cancers. However, there are currently no guidelines available for metastatic disease. In the UK, nearly half of all colorectal cancer patients develop hepatic metastases. Timely, surgical resection offers the potential for cure. The aim of this study was to audit current practice for colorectal liver metastases in a regional hepatobiliary unit, and compare this to the NHS Cancer Plan standards for primary disease.
  
  
  METHODS
  A retrospective review of the unit's database was performed for all hepatic metastases referrals from January 2006 to December 2008. The dates of referral, first appointment, investigations and initiation of treatment, along with patient's age and sex, were recorded on Microsoft Excel and analysed. Time was expressed as mean +/- SD in days.
  
  
  RESULTS
  A total of 102 patients with hepatic metastases were identified. Five were excluded due to incomplete data. The average time from referral to first appointment was 10.6 +/- 9.4 days and the average time from referral to treatment was 38.5 +/- 28.6 days. Seventy-five (72.7%) had surgical intervention, of whom 37 also had chemotherapy.
  
  
  CONCLUSIONS
  The data compare favourably to the NHS Cancer Plan guidelines for primary malignancy, demonstrating that a regional hepatobiliary unit is capable of delivering a service for colorectal liver metastases that adheres to the NHS Cancer Plan. Therefore, the NHS Cancer Plan can be applied to this cohort.
authors.affiliation: Hepatobiliary Surgical Unit, Mater Hospital, Belfast, UK. cjones82@hotmail.co.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Jones
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Badger
authors.forename: Jane
authors.initials: J
authors.lastname: McClements
authors.forename: Lloyd
authors.initials: L
authors.lastname: McKie
authors.forename: Tom
authors.initials: T
authors.lastname: Diamond
authors.forename: Mark A
authors.initials: MA
authors.lastname: Taylor
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009660:Northern Ireland; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D013222:State Medicine / Q000592:standards*; D013997:Time Factors; D014850:Waiting Lists