Bowel cancer targets 'ineffective'

Bowel cancer is a major killer

The two-week maximum wait to see a specialist for UK patients with suspected bowel cancer does not seem to be working well, research suggests.

Researchers compared the treatment received by patients referred to a two-week clinic with those who received more routine care.

They found the fast-track patients were not treated any more quickly, nor was their disease caught earlier.

The study, in Gut, took place at Portsmouth's Queen Alexandra Hospital.

The researchers also found many GPs were still unsure about some of the "high-risk" criteria for referral.

The government introduced the two-week standard in July 2000 to try to ensure suspected cancer cases were dealt with at an early stage.

The authors audited the referrals of all bowel cancer patients at one district hospital over 12 months.

During that time, 249 bowel cancers were diagnosed.

But only one in four (26%) was an urgent two-week referral.

Of the remainder, 16% were diagnosed at routine outpatient bowel disease clinics; one in four at other clinics; and just over a third (35%) were emergency admissions.

Thirteen patients a week received a two-week referral to a specialist, most of whom (85%) were seen within that time.

Diagnosis figures

What really counts is once you have been diagnosed how long you have to wait to surgery

Dr Richard Sullivan

The diagnosis rate was high, with almost one in 10 patients (65 out of 695) diagnosed with bowel cancer, compared with around one in 50 (40 out of 1,815) in routine clinics.

This suggests referral criteria are not the problem. But most (85%) of those referred to routine clinics who were subsequently diagnosed with bowel cancer had met the criteria for urgent referral.

The researchers also discovered time lags before referral by the GP, and after the first outpatient appointment, actually meant referral to the two-week clinic had little impact on waiting times for treatment. As a result, their disease was not caught at an earlier stage.

In the journal, the researchers say more resources are needed to tackle delays in the system.

"Ultimately the value of the two-week standard is small in the context of a process of care that is slow, both before referral and after being seen in outpatients."

Wrong emphasis

Dr Richard Sullivan, head of clinical programme at Cancer Research UK, said the study highlighted the limited value of concentrating on waiting times.

"Waiting times are an easy target, and it is psychologically nice for patients to be seen quickly," he said.

"But what really counts is - once you have been diagnosed - how long you have to wait for surgery, how good that surgery is, and how good other treatments such as chemotherapy and radiotherapy are."

Jola Gore-Booth, chief executive of the charity Colon Cancer Concern, told BBC News Online: "While there are still problems in relation to bowel cancer services, clinicians and patients tell us the picture is improving.

"Patients are becoming better informed and GPs are prioritising the disease more - by undertaking more examinations and referring more patients."