Colon cancer two-week rule is revised

Over half of general practices in England are failing to use the two-week-wait referral system to diagnose colorectal cancer, according to UK research.

The two-week-wait referral guidelines for colorectal cancer were introduced in July 2000 to help GPs prioritise referral and improve awareness of symptoms among the profession.

However, the study found that up to a quarter of GPs in England were unaware of the referral guidelines. With only 8 per cent knowing the steps in the referral procedure.

For the study, the researchers assessed patients at 49 general practices, using a database to identify all diagnoses of colorectal cancer in the 12 months from April 2004.

Patients were cross-referenced via GP codes to identify the referral origin.

A postal questionnaire was sent out to all the GPs who had identified the colorectal cancer to assess their method of referral and their knowledge of the two-week guidelines.

A total of 175 patients diagnosed with colorectal cancer were referred from 49 general practices. Twenty-six of these practices, (53 per cent), had no colorectal cancer diagnosed via the two-week-wait referral guidelines, while the postal survey revealed that 22 per cent of GPs were unaware of the two-week guidelines.

The researchers, led by Dr Solomon John, from the Royal Bournemouth Hospital in Dorset, said: 'The postal survey highlights the knowledge and education gap within primary care in relation to the two-week referral and we can speculate that these factors part explain the variability in referral practice.'

The researchers say that GP education is needed to improve implementation of the existing referral guidelines.

Surrey GP Dr Peter Smith, from Kingston, who has an interest in colorectal cancer, said findings of the study were worrying.

'It is absolutely crucial that GPs use the two-week-wait referral guidelines when dealing with colorectal cancer.

'We owe it to our patients to use the guidelines. Without them, patients may have to wait three or four months before they can be referred,' he said.

'I would agree that more GP education is needed to raise awareness of the guidelines,' added Dr Smith.

- Colorectal Disease 2007; 9: 731-5

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