Changing referral patterns and colorectal cancer (CRC) detection rates over 10 years in a UK specialist centre.


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Elena Velten1,Angus McNair1
1Gloucestershire NHS Trust

Abstract

Background

Suspected CRC referral guidelines aim to fast-track patients for specialist assessment, however, the long-term impact of such guidelines is unclear. This study compared referral rates, fulfilment of referral criteria and CRC detection over a 10 year interval.

Method

All fast-track referrals to a single UK CRC centre were identified prospectively over a 9-week period in 2007 and 7-week period in 2016. Referral reasons were documented as 1) change in bowel habit to looser stools persistent for 6 weeks with rectal bleeding for all ages or 2) without rectal bleeding for ages over 60, 3) rectal bleeding persistently without anal symptoms, 4) a definite palpable rectal mass or 5) right-sided abdominal mass for all ages, or 6) iron deficiency anaemia (IDA) without an obvious cause for ages over 60. Fulfilment of these criteria was assessed by specialist colorectal surgeon, and CRC detection rates were recorded. Comparisons were made between the two time periods using descriptive statistics and Fisher’s exact test.

Results

A total of 102 patients were referred in 2007 compared to 203 in 2016, equating to an average of 11/week and 29/week respectively. Fulfilment of referral criteria was similar in 2007 (63/102, 61.8%) and 2016 (136/203, 67.0%). CRC detection rates decreased from 12/102 patients (11.8%) to 12/203 patients (5.9%) in the time interval. Overall, CRC detection was significantly higher when patients fulfilled the referral criteria (22/199 (11%) versus 2/106 (2%) patients, p=0.003).

Conclusion

Fast-track CRC referrals have increased between 2007 and 2016 and the CRC detection rates have fallen. Only two thirds of patients fulfilled fast-track criteria on specialist assessment. Fast-track criteria fulfilment was associated with CRC detection, but some patients had CRC that did not meet referral criteria. Adequate resources are required for specialist assessment of high risk patients.