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Abstract
Aim The 2-week-wait (2ww) pathway for early detection of suspected cancer was recently revised (NICE Guidelines 2015: NG12), to further improve cancer detection and cure rates. We aimed to audit patients referred via the 2ww pathway and also review the referral pathway for children with a confirmed cancer diagnosis during the same time period.
Method A retrospective analysis of case notes of children referred via the 2ww pathway, between December 2012–December 2014. The same analysis was performed for children with a confirmed cancer diagnosis made during the same time frame who were cared for at our centre.
Results 83 patients (46% male) were referred via the 2ww pathway, of which 1 had cancer. More than 90% were seen within 2 weeks. 5 did not attend.
Conclusion Whilst childhood cancer is rarely diagnosed via the 2ww pathway, the odds of diagnosing cancer in this pre-screened group is greater than via presentation in the Emergency Department, (ED). (Odds ratio 139 [1/83 vs. 6/69300]; P < 0.0000001). However presentation to ED is a common referral route because of the acute nature of disease onset, anxiety around diagnosis and easy access. The 2ww pathway gives General Practitioners (GPs) direct access to urgent specialist opinion Additionally, non-malignant pathology which mimics cancer can be diagnosed and managed promptly. Finally, the RCPCH Facing the Future standard, of consultant review within 24 h facilitates meeting the 2ww target. Other service changes such as joint GP clinics, phone contact with consultants, and Rapid Access Clinics can also ensure timely reviews of children with suspected cancer.
Shows a positive skew in referrals of older children
Illustrates the most commonly referred to specialties. 74% underwent investigations. 1 was referred to an oncologist; 9 to other specialties; 31 were followed up; and 39 discharged. Diagnoses included: 74 non-malignant pathologies; 1 malignancy; 3 well children; and 1 had no notes. 18 children (50% male) were diagnosed with cancer during the study period
Illustrates referral route. Only 1 was identified via the 2ww pathway