The two-week wait (TWW) colorectal cancer (CRC) referral path does not deliver benefit compared with other pathways. That is the finding of a systematic review and meta‐analysis of available national evidence on key outcomes of the lower gastrointestinal (GI) two‐week wait pathway.
Through a comprehensive literature search conducted between 2000 and 2017, 49 eligible papers with a total population of 93,655 individuals were analysed.
The data revealed an unexpectedly low pooled CRC conversion rate of just 7.7% in those with gastrointestinal symptoms. This was comparable to the cancer detection rate of the asymptomatic UK Bowel Cancer Screening Population (8%).
This is the first systematic review to document staging data for the TWW lower GI cohort. It found that only 11.2% of the participants were at an early stage (Dukes A) at diagnosis, with the remainder at more advanced stages. Importantly, there was no statistically significant difference in the distribution of staging observed in the TWW cohort compared with CRC diagnosed via any non‐TWW route combined. Nearly half of patients presented with stage III or IV disease, with corresponding survival of 47.7% and 6.6%, respectively. The figures show that stratification by symptoms alone, regardless of how quickly patients are seen, does not improve CRC detection or staging.
More than half (54.6%) of patients seen via the TWW pathway had normal colonic examinations. Cases of inflammatory bowel disease (IBD) and non‐CRC cancer were less than 4%.
The authors say: “These results should prompt a reconsideration of the benefits of the TWW pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.”
