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The 2-week wait referral system does not improve 5-year colorectal cancer survival


A. Zafar, Department of General Surgery, Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham, B75 7RR, UK.


Aim  The aim of this study was to compare 5-year survival rates in colorectal cancer (CRC) patients who underwent potentially curative surgery before and after the introduction of the 2-week wait (2WW) referral system.

Method  Data were collected retrospectively from a prospectively maintained cancer database for CRC patients who underwent surgery in 1999 (pre-2WW group, = 150) and 2002 (post-2WW group, = 126). Patients who presented as an emergency, those who died within 30 days of surgery and those who presented with incurable CRC were excluded. We used the Kaplan–Meier method to plot survival curves and the log rank test to compare survival rates between the two groups.

Results  The 5-year survival rates in the pre-2WW and post-2WW groups did not differ significantly (71%vs 72%, respectively; = 0.880). The number of CRC patients who presented via urgent pathways was higher in the post-2WW group than in the pre-2WW group (77%vs 38%, < 0.001). Further, owing to this change in the referral pattern, the overall delay between referral and treatment was significantly lower in the post-2WW group than in the pre-2WW group (median 76 days vs 115, = 0.009).

Conclusion  The 2WW referral system for patients with symptoms of CRC does not translate into improved survival. However, more patients with symptomatic CRC are being referred via urgent pathways.