Non-Attendance in Two-week wait and Urgent Colorectal Cancer Referrals


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Vincenza Scanella1,Harpreet Sekhon Inderjit Singh2,Rabiya Aseem2,Jason Smith2,Nikhil Pawa2
1Imperial College London, London, UK,2West Middlesex University Hospital, Isleworth, UK

Abstract

Background

Colorectal cancer (CRC) is the second commonest cause of cancer death in the UK, attributing to 10% of cancer mortality. Survival is dependent upon early detection. The Two-week-wait (2WW) referral pathway was implemented in the UK in July 2000 to reduce delays in diagnosis and decrease mortality associated with CRC. Non-attendance of these appointments has adverse clinical outcomes for patients. The reasons for non-attendance are not clearly understood with no quantitative research previously performed. This study aims to determine the association between Age, Sex, Ethnicity, Geographical location (postcode) and Socioeconomic status (SES) on non-attendance in 2WW and urgent CRC referrals.

Method

A retrospective analysis of a prospectively collated database of 2WW and urgent CRC referrals at our unit from January 2016 to December 2018 was performed. Variables regarding patient age, sex, attendance status, ethnicity (Census 2011), postcode, and socioeconomic status were recorded. Chi-squared, Spearman’s Rank and multivariate analyses were performed to determine the relationship between these variables and non-attendance. The White-British population was used as the control group.

Results

A total of 9,829 patients (49.45% male, 50.55% female, mean age 64.42 years) were analysed with an overall non-attendance rate of 12.31% (1,210/9,829). There was an increased non-attendance risk in 1) Younger populations (Age <55 years: OR=1.189 CI=1.049-1.349 p=0.0076); 2) Three ethnic cohorts: Asian Other (OR=0.6778 CI=0.5151-0.892 p=0.0067), Black Other (OR=0.3852 CI=0.2046-0.7255 p=0.0045) and Not Stated (OR= 0.8102 CI=0.2162-0.3321 p=0.011); 3) Six postcodes (p <0.05) of which non-attendees in TW3 also had a significant risk of social deprivation. There was no correlation between gender or SES and non-attendance. Multivariate analysis confirmed the association between age and non-attendance (p=0.0012).

Conclusion

This novel study has identified high-risk groups for non-attendance. Further qualitative research into high-risk groups needs to be performed to allow early detection and diagnosis of CRC and improve clinical and oncological outcomes.