TITLE:
Are “Straight to Test” Pathways Always Best for Patients? A Prospective Observational Study of Two-Week-Wait Colorectal Referrals
AUTHORS:
Frances Mosley, Jon R. Ausobsky, John P. Griffith
KEYWORDS:
Colorectal Neoplasms (MeSH); Endoscopy; Gastrointestinal (MeSH); Colorectal Surgery (MeSH); 2-Week-Wait; Fast-Track; Straight to Test (No MeSH Term)
JOURNAL NAME:
Surgical Science,
Vol.4 No.10,
October
22,
2013
ABSTRACT: Aim: Many centres have
adopted a straight to test approach to deliver a fast-track service for
suspected lower GI cancer. We undertook a prospective comparison between
patients having a straight to test (STT) flexible sigmoidoscopy and those
attending an outpatient appointment (OPA). The study aimed to determine whether
STT reduced diagnostic time without additional investigations. Methods: An observational study of 200
consecutive fast-track colorectal referrals was undertaken. Data collected
included: patient demographics, whether STT or OPA, investigations undertaken
(including dates) and final diagnosis. Outcomes were compared by adjusted
linear regression and logistic regression, for numerical and binary outcomes respectively.
Potential confounding factors included were: age, gender and whether NICE
referral criteria were achieved. Results: 186 out of 200 referrals attended their appointment, 62% (116/186) went STT and
38% (70/186) had an OPA. No significant difference was seen in the number of
days to final investigation, adjusted
coefficient -3.71, 95% C.I. -8.92
to 1.50. The STT group had 0.4 more tests per patient, adjusted 95% C.I. 0.07 to 0.73, than the OPA group. Significantly
more patients in the STT group had a flexible sigmoidoscopy in addition to
whole colonic imaging (all modalities), compared to the OPA group, adjusted OR of 93.47 (95% C.I. 29.26 to
298.54). Conclusion: This study
highlights the potential disadvantages of STT flexible sigmoidoscopy for
patients referred under the two-week-rule with suspected lower GI cancer. Despite
the previously published work highlighting the potential cost and time benefits,
it may come at the sacrifice of exposing patients to additional investigations.