title: The 2-week wait service: a UK tertiary colorectal centre's experience in the early identification of colorectal cancer.
abstract: OBJECTIVE
  National Institute for Health and Clinical Excellence (NICE) guidelines were introduced in the UK to ensure that patients with high-risk symptoms of colorectal cancer were reviewed promptly. We assessed the proportion of patients referred to our department's nurse-led 2-week wait (2WW) clinic with high-risk symptoms or signs that met these guidelines and the rate of colorectal cancer pickup.
  
  
  METHODS
  Patients were identified from a prospectively maintained logbook of 2WW referrals over a 1-year period (1 January 2008-31 December 2008). Computerized notes were reviewed to obtain the following information: referral symptoms or signs and the proportion of patients diagnosed with colorectal cancer.
  
  
  RESULTS
  A total of 720 patients were seen in the 2WW clinic over this period. Only 356/720 (49.4%) met the referral criteria. The overall pickup rate of colorectal cancer was 52/720 (7.2%) and was not found to be significantly higher in patients meeting guidelines compared with those who did not exhibit these features (7.6 vs. 6.9%; P=0.771). Over the 5-year follow-up period, no patients discharged from the 2WW pathway subsequently re-presented with colorectal cancer.
  
  
  CONCLUSIONS
  Over half of the referrals did not meet the NICE criteria, suggesting that the system is being used as a rapid access route to investigation. Despite this, there is no significant difference in the pickup rate of colorectal cancer in patients with or without high-risk features. Nurse-led 2WW clinics with subsequent investigation appear to be effective in both the identification and exclusion of colorectal cancer.
authors.affiliation: Department of Colorectal Surgery, Academic Surgical Unit, Castle Hill Hospital, Cottingham, UK.
authors.forename: Rikesh K
authors.initials: RK
authors.lastname: Patel
authors.forename: Adele E
authors.initials: AE
authors.lastname: Sayers
authors.forename: Shahid
authors.initials: S
authors.lastname: Seedat
authors.forename: Talal
authors.initials: T
authors.lastname: Altayeb
authors.forename: Iain A
authors.initials: IA
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003287:Contrast Media; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D004739:England / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012812:Sigmoidoscopy; D062606:Tertiary Care Centers / Q000592:standards; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate