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Br J Gen Pract. May 1, 2006; 56(526): 355–362.
PMCID: PMC1837844
Urgent GP referrals for suspected lung, colorectal, prostate and ovarian cancer
Victoria L Allgar, BSc (Hons) CStat, PhD, Director of YReN and Senior Research Fellow
Centre for Research in Primary Care, Institute of Health Sciences and Public Health Research, University of Leeds, Leeds
Richard D Neal, PhD, MRCGP, Senior Lecturer in General Practice
North Wales Clinical School, Department of General Practice, Cardiff University, Wrexham
Nasreen Ali, BSc (Hons), PhD, Senior Research Fellow, Brenda Leese, BSc (Hons), DPhil, Reader in Primary Care Research, Phil Heywood, FRCGP, DCH Dobst, Professor of Primary Care Development, Gill Proctor, Research Nurse, and Joyce Evans, Research Nurse
Centre for Research in Primary Care, Institute of Health Sciences and Public Health Research, University of Leeds, Leeds
Address for correspondence Richard D Neal, Senior Lecturer in General Practice, North Wales Clinical School, Department of General Practice, Cardiff University, Wrexham Technology Park, Wrexham LL13 7YP. E-mail: nealrd/at/cf.ac.uk
Received April 7, 2005; Revised July 13, 2005; Accepted October 11, 2005.
Abstract
Background
The UK urgent cancer referral guidance was introduced between 1999–2000. There is a dearth of literature relating to the effectiveness in detecting cancer of urgent suspected cancer referrals and general practitioners' compliance with the guidance.
Aims
This paper aims to determine the diagnostic yield from urgent referrals for suspected colorectal, lung, ovarian and prostate cancer, and the proportion of patients with cancer who were urgently referred. Secondary aims are to determine the association of these findings with age, ethnicity, sex and marital status, and to determine the proportions of patients who fulfilled the urgent referral criteria.
Design
Detailed notes analysis of all urgent referrals and all cancer diagnoses.
Setting
One hospital trust in England.
Method
Data regarding all urgent referrals and all cancer diagnoses were obtained from one hospital trust over a 2-year period. Data analysis was undertaken to determine, diagnostic yields and their association with sociodemographic factors, trends over time and fulfilment of the guidance.
Results
The percentages of urgent referrals diagnosed with cancer were colorectal 11%, lung 42%, ovarian 20%, and prostate 50%. The percentages of patients with cancer referred urgently were colorectal 21%, lung 23%, ovarian 24%, and prostate 32%. Patients who were urgently referred without cancer were younger than those with cancer for all but prostate. There were no significant differences by sex, marital status or ethnicity. For patients with cancer there were no differences for any sociodemographic factors in whether or not they were referred urgently.
Conclusions
The predictive power of the referral guidance as a marker for cancer is low, resulting in significant numbers of patients being urgently referred without cancer. A large majority of patients not diagnosed with cancer through the urgent referral route did fulfil the criteria for urgent referral, suggesting that with more widespread use of the guidance the diagnostic yields will be higher. This has implications for patients, on hospital diagnostic systems, and for patients presenting through other pathways.
Keywords: colorectal cancer, lung cancer, ovarian cancer, prostate cancer, referral
Articles from The British Journal of General Practice are provided here courtesy of
Royal College of General Practitioners