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G13 How effective is the 2 week urgent referral pathway in identifying paediatric cancer? experience from a general paediatric hospital and literature review
  1. P Galloway,
  2. J Arumugam,
  3. J Hargreaves,
  4. E Tsouana
  1. Paediatrics, Basildon and Thurrock University Hospitals NHS Trust, Basildon, UK

Abstract

Introduction In June 2015, NICE published the updated guidance on referrals for suspected cancer, recommending urgent review within 2 weeks by a paediatric specialist. In this study, we report the experience of our local paediatric oncology shared care unit (POSCU), looking at the effectiveness of this pathway and summarise the published experience to date from other POSCUs.

Methods Retrospective analysis of all cases referred via the 2 week wait (2ww) pathway from April 2012 to October 2015, as well as all confirmed paediatric oncology cases in the same period. Data on reason for referral, diagnosis and outcome were collected via the patients’ electronic records. Two publications from similar POSCUs were identified by medline search and results were compared and summarised.

Results During the selected time period, 83 children of ages ranging 0–16yrs (mean age 8.8yrs) were seen via the 2ww (2 weeks wait) pathway, out of which only 2 were confirmed to have cancer. The commonest reasons for referral were lymphadenopathy (36%), soft tissue swellings (25%) and breast lumps (11%). In the same time period 35 children were diagnosed with cancer in our POSCU. Sixty three percent presented via the Emergency department (ED), 22% presented through outpatient clinics and 10% presented via other routes. When compared with published experiences from other POSCUs, the above data was found to be similar. The combined data of all three units show that the yield for diagnosing cancer through 2ww pathway is only 2.1% for a total of 234 referrals (Table 1).

Abstract G13 Table 1

Results of the 2 week urgent referral pathway

Conclusion The 2ww pathway has very low yield in diagnosing paediatric cancer, as most cases continue to present through the emergency services. Further research is needed to identify the ideal timeframe and setting for such referrals and optimise the diagnostic process.

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