Article Text

PDF
112
TWO-WEEK WAIT REFERRALS FOR CNS CANCER-ARE THEY WORKING?
  1. J Panicker*,
  2. AJ Larner
  1. Walton Centre for Neurology and Neurosurgery

    Abstract

    Concerns about validity of the 2 week wait referral criteria for CNS cancers have been raised in the past. In 2005 a systematic review of cancer 2 week wait referrals across various specialties found only one suitable audit on CNS cancer, with low pick up rate (<10%).

    Methods Seventy case notes of patients referred between May and August 2010 to the Walton Centre in Liverpool as 2 week wait referrals were reviewed, reasons for referral validated against referral criteria based on NICE Guidelines and the appropriateness of the referrals reassessed. Forty-eight case notes were independently examined by a second assessor and kappa statistic was calculated.

    Results Eight patients (11%) were diagnosed to have a CNS tumour of which five (7%) turned out to be malignant. Of the eight patients, diagnosis was known in five patients before referral, giving a pick-up rate for new CNS tumours of only three (4.6%) from the 2 week referrals. By application of 2 week wait referral criteria in retrospect, 58 out of 70 referrals (82%) did not fulfil the criteria, including three patients who were diagnosed to have cancer. There was inter-rater agreement on adherence to criteria in all but two cases (Kappa statistic=0.83). The criteria were found to have low sensitivity (0.62) and positive predictive values (0.41), undesirable for a screening test, but better specificity (0.89) and negative predictive value (0.95).

    Conclusions Pick-up rates for new cancers using current 2 week wait referral criteria are very low. Revision of the current criteria is needed.

    Statistics from Altmetric.com

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.