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Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer

BACKGROUND: Cancer survival in the UK has doubled in the last 40 years; however, 1-year and 5-year survival rates are still lower than other countries. One cause may be a delay between referral into secondary care and subsequent investigation. We set out to evaluate the impact of a straight to test...

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Autores principales: Jones, James Andrew, Catton, James, Howard, Glen, Leeder, Paul, Brewer, Lesley, Hatton, James, Shaw, Dominick E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059286/
https://www.ncbi.nlm.nih.gov/pubmed/30057958
http://dx.doi.org/10.1136/bmjoq-2018-000328
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author Jones, James Andrew
Catton, James
Howard, Glen
Leeder, Paul
Brewer, Lesley
Hatton, James
Shaw, Dominick E
author_facet Jones, James Andrew
Catton, James
Howard, Glen
Leeder, Paul
Brewer, Lesley
Hatton, James
Shaw, Dominick E
author_sort Jones, James Andrew
collection PubMed
description BACKGROUND: Cancer survival in the UK has doubled in the last 40 years; however, 1-year and 5-year survival rates are still lower than other countries. One cause may be a delay between referral into secondary care and subsequent investigation. We set out to evaluate the impact of a straight to test pathway (STTP) on time to diagnosis for upper gastrointestinal (UGI) cancer. METHODS: Six hospital Trusts across the East Midlands Clinical Network introduced a STTP enabling general practitioners to refer patients with suspected UGI cancer (oesophageal/gastric) for immediate investigation, without the need to see a hospital specialist first. Data were collected for all patients referred between 2013 and 2015 with suspected UGI cancer and stratified by STTP or traditional referral pathway. Overall time from referral to diagnosis was compared. Data from two Trusts who did not implement STTP acted as control. RESULTS: 340 patients followed the STTP pathway and 495 followed the traditional route. STTP saved a mean of 7 days from referral to treatment (with a 95% CI of 3 to 11 days, p<0.008) and a mean of 16 days from referral to diagnosis, when compared with a traditional referral pathway. The number of diagnostic tests performed using STTP or traditional referral pathways were similar. CONCLUSION: A STTP is associated with an overall reduction of 1 week from referral to treatment for UGI cancer. The approach is feasible and did not require more resource. Larger studies are required to assess whether this time saving translates into improved cancer outcomes.
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spelling pubmed-60592862018-07-27 Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer Jones, James Andrew Catton, James Howard, Glen Leeder, Paul Brewer, Lesley Hatton, James Shaw, Dominick E BMJ Open Qual Original Article BACKGROUND: Cancer survival in the UK has doubled in the last 40 years; however, 1-year and 5-year survival rates are still lower than other countries. One cause may be a delay between referral into secondary care and subsequent investigation. We set out to evaluate the impact of a straight to test pathway (STTP) on time to diagnosis for upper gastrointestinal (UGI) cancer. METHODS: Six hospital Trusts across the East Midlands Clinical Network introduced a STTP enabling general practitioners to refer patients with suspected UGI cancer (oesophageal/gastric) for immediate investigation, without the need to see a hospital specialist first. Data were collected for all patients referred between 2013 and 2015 with suspected UGI cancer and stratified by STTP or traditional referral pathway. Overall time from referral to diagnosis was compared. Data from two Trusts who did not implement STTP acted as control. RESULTS: 340 patients followed the STTP pathway and 495 followed the traditional route. STTP saved a mean of 7 days from referral to treatment (with a 95% CI of 3 to 11 days, p<0.008) and a mean of 16 days from referral to diagnosis, when compared with a traditional referral pathway. The number of diagnostic tests performed using STTP or traditional referral pathways were similar. CONCLUSION: A STTP is associated with an overall reduction of 1 week from referral to treatment for UGI cancer. The approach is feasible and did not require more resource. Larger studies are required to assess whether this time saving translates into improved cancer outcomes. BMJ Publishing Group 2018-07-21 /pmc/articles/PMC6059286/ /pubmed/30057958 http://dx.doi.org/10.1136/bmjoq-2018-000328 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Article
Jones, James Andrew
Catton, James
Howard, Glen
Leeder, Paul
Brewer, Lesley
Hatton, James
Shaw, Dominick E
Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
title Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
title_full Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
title_fullStr Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
title_full_unstemmed Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
title_short Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
title_sort impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059286/
https://www.ncbi.nlm.nih.gov/pubmed/30057958
http://dx.doi.org/10.1136/bmjoq-2018-000328
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