Outcomes in 2748 patients referred to a colorectal two-week rule clinic

  1. R. A. Smith,
  2. O. Oshin,
  3. J. McCallum,
  4. J. Randles,
  5. S. Kennedy,
  6. S. Delamere,
  7. P. S. Rooney,
  8. P. S. Carter

Article first published online: 12 SEP 2006

DOI: 10.1111/j.1463-1318.2006.01048.x

Issue

Colorectal Disease

Colorectal Disease

Volume 9, Issue 4, pages 340–343, May 2007

Additional Information

How to Cite

Smith, R. A., Oshin, O., McCallum, J., Randles, J., Kennedy, S., Delamere, S., Rooney, P. S. and Carter, P. S. (2007), Outcomes in 2748 patients referred to a colorectal two-week rule clinic. Colorectal Disease, 9: 340–343. doi: 10.1111/j.1463-1318.2006.01048.x

Author Information

  1. Department of Surgery, Royal Liverpool University Hospital, Liverpool, Merseyside, UK

*R. A. Smith, Department of Surgery, Countess of Chester Hospital, Chester CH2 1UL, UK. E-mail: richsmith@doctors.org.uk

Publication History

  1. Issue published online: 12 SEP 2006
  2. Article first published online: 12 SEP 2006
  3. Received 31 August 2005; accepted 31 January 2006

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Keywords:

  • Colorectal cancer;
  • two-week rule;
  • nurse-led clinic

Abstract

Objective  To assess the 3-year outcomes of a nurse-led, one-stop, 2-week rule (TWR) clinic for suspected colorectal cancer (CRC) in a large teaching hospital.

Method  Data were collected prospectively from January 2002 to December 2004. In total, 2748 patients were seen over the 3-year period. The ratio of male:female subjects was 1190:1558 (43%:57%). Median age at presentation was 66 years (range 17–96).

Results  A total of 1363 (49.6%) nonconforming referrals were made; 1300 patients (47.3%) underwent flexible sigmoidoscopy during their initial assessment in clinic; 1439 patients (52.4%) underwent a barium enema during the course of their investigation; 2503 patients (91.1%) were seen within 14 working days. The median overall wait for the initial clinic appointment was 10 days. The annual number of patients seen was similar over the 3-year period. A total of 174 cancers (6.3%) were identified which accounted for 36.4% of all CRCs diagnosed during the study period. Nineteen cancers presented in the nonconforming group (1.6% of all non-conforming patients). Rectal tumours accounted for 59.8% (n = 104) of all cancers diagnosed while right-sided tumours accounted for only 10.9% (n = 19). Advanced tumours accounted for 73.0% (n = 127) of the total; 133 (76.4%) cancer patients underwent some form of surgical intervention.

Conclusion  A specialist nurse-led, one-stop TWR clinic for suspected colorectal cancer is sustainable and can be run successfully with over 90% of referrals seen within the targeted time period. The proportion of non-conforming referrals was high and a large number of advanced and unstaged tumours was observed. Low numbers of proximal tumours were detected.

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