Two-week wait referral experience for suspected colorectal cancer in young adults - symptoms at presentation and compliance with NICE (NG12) national referral guidelines
Ayush Kapila1, Krashna Patel1,Meera Tharmaratnam1, Harjot Birdi1, Nadine Davies1, Narasimhaiah Srinivasaiah1
1Department of Colorectal Surgery, Princess Alexandra Hospital, Harlow
Aims: Colorectal cancer (CRC) incidence in young adults is on the rise1. NICE published updated guidance in June 2015 (NG12) outlining referral criteria for young adults (<50 years) under the two-week wait rule. This study aims to characterise referrals to secondary care and assess guideline compliance.
Methods: Retrospective analysis was performed of patients under the age of 50 referred under the two-week-wait rule between July 2015 and October 2017 following updated NICE guidelines (NG12). Patients were analysed for demographic data, reasons for referral, diagnosis and compliance to NICE NG12 guidelines.
Results: Data from 105 patients was analysed (median age, 44 years). 57% (60/105) of patients were male. 66% of patients had at least two symptoms at referral with the most common symptoms being change in bowel habit (69%), PR bleeding (65%) and abdominal pain (45%). Other symptoms were weight loss (24%), rectal mass (4%), abdominal mass (3%), iron-deficiency anaemia (2%) and tenesmus (1%). 42% of referrals did not comply to the NG12 referral guidelines. In the remaining 58%, 1 ovarian and 1 rectosigmoid malignancy were diagnosed (1.9% total cancer yield, 0.9% CRC yield).
Conclusions: We observe a low cancer yield of patients under the age of 50. Change in bowel habit, rectal bleeding and abdominal pain were found to be the most common reasons for referral. According to the updated NICE NG12 guidelines (June 2015), only 58% of referrals were compliant. As such, more specific referral criteria and clarification of guidelines are required for more targeted referrals to secondary care.
1Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RG, Barzi A, Jemal A. Colorectal cancer statistics, 2017. CA: a cancer journal for clinicians. 2017 May 6;67(3):177-93.