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Analysis of referral pathways in patients diagnosed with urological cancer

Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) with those referred in a standard manner and subsequently diagnosed as having urological cancer. Patients and methods: A retrospective case note review was undertaken of 209 patients coded as having urological cancer over a six-month period. Patients that were not referred through either pathway, who had no symptoms or signs suspicious of cancer or who did not have a newly-diagnosed cancer during this period were excluded. The dates of relevant clinical events within each patient pathway were recorded and compared (e.g. dates of referral, first clinic appointment, diagnosis and first treatment). Results: Of the 209 cases reviewed, 58 cases were excluded. Eighty-two cases were referred through the standard referral pathway and 69 by the 2WR. Overall, patients referred through the 2WR pathway were seen sooner, had their cancer diagnosed earlier and received treatment more quickly than those referred through the standard route. However, the delay between diagnosis and treatment was similar for both groups. Prostate cancer accounted for two thirds of diagnoses, with 54% of 2WR referrals having advanced disease and 66% of cases with localised disease being referred by the standard route. Conclusion: The 2WR accelerates all clinical event times but with little clinical advantage to the patient. The 2WR for suspected cancer should be abandoned in favour of retention of the existing 18-week standard for the commencement of treatment following referral.