To make analysis as pragmatic as possible, and not simply a study of the guidelines, a sub-analysis of the data was performed combining all urgent referrals (that is, urgent guideline referrals and GP letters marked as urgent) compared with all other referrals.
How this fits in
Very few studies have reported cancer outcomes from patients referred through different routes; despite the prominence of current UK cancer urgent referral guidance. The current findings show that for patients with lung cancer the UK urgent referral guidance is prioritising those with more advanced disease: those who have least to gain in terms of morbidity and mortality from treatment. This was not the case for colorectal, prostate, or ovarian cancer. While urgently referred patients are diagnosed more quickly, the benefits to these patients and the potential detriment to patients diagnosed through non-urgent routes remain unknown.
In this paper data are reported for those patients with cancer whose hospital medical records were available (65% lung, 60% colorectal, 57% prostate, 83% ovarian). The process of retrieving records and the reasons for missing data have been previously reported.6 Patients with ovarian or prostate cancer were allocated to the urgent guideline referral group if they were referred as part of the urgent gynaecological or urological guidance respectively.
Box 1. Summary of guidance for urgent referral
Lung
▸ Chest X-ray suggestive of lung cancer
▸ Persistent haemoptysis in smokers/ex-smokers over 40 years of age
▸ Signs of superior vena cava obstruction
▸ Stridor
▸ History of asbestos exposure and unexplained symptoms or suspicious chest X-ray
Colorectal
▸ A definite palpable right-sided abdominal mass (any age)
▸ A definite palpable rectal (not pelvic) mass (any age)
▸ Rectal bleeding WITH a change in bowel habit to looser stools and/or increased frequency of defecation persistent for 6 weeks (any age)
▸ Rectal bleeding persistently WITHOUT anal symptoms (anal symptoms include soreness, discomfort, itching, lumps and prolapse as well as pain) (over 60 years)
▸ Change in bowel habit to looser stools and/or increased frequency WITHOUT rectal bleeding and persistent for 6 weeks (over 60 years)
▸ Iron deficiency anaemia WITHOUT an obvious cause (Hb<11 g/dl in men and Hb<10 g/dl in non-menstruating women) (any age)
Prostatea
Ovarianb
aProstate-specific criteria as part of the ‘urological’ guidance. PSA = prostate specific antigen.
bOvarian-specific criteria as part of ‘gynaecological’ guidance.