The ‘two week wait rule’ is failing breast cancer patients and needs to be reviewed urgently say the authors of a seven year study examining the impact of the target, published today on bmj.com.
At the end of the last century death rates from breast cancer in the UK were among the highest in Europe. Long waiting lists, resulting in delayed diagnosis and treatment, were thought to be partly responsible. In 1998 the Department of Health brought in the ‘2 week wait rule’ which stipulated that by April 1999 all patients with suspected breast cancer should be seen by a specialist within two weeks of referral by a GP.
Many studies have questioned the validity of the 2 week wait rule, but this is the first to assess the long term impact. Dr Shelley Potter and her colleagues gathered data on the number, route and outcome of Primary Care referrals to the Frenchay Brest Care Centre in Bristol between 1999 and 2005.
There were 24,999 referrals to the centre during this period, with GPs classifying each patient as being either ‘urgent’ according to 2 week wait criteria or ‘routine’. Between 1999 and 2005 the number of annual referrals to the centre increased by 9%.
Routine referrals decreased by 24% but 2-week wait referrals increased by 42%. Despite the changes in referral patterns the total number of cancers remained constant over the 7 year period.
Yet the researchers found the percentage of patients diagnosed with cancer in the 2-week wait group decreased from 12.8% to 7.7% whilst the number of cancers detected in the ‘routine’ group increased from 2.5% to 5.3% over the same time period. In 2005 more than 1 in 4 (27%) patients ultimately diagnosed with cancer in 2005 was referred non-urgently. Dr Potter describes the increase in cancers diagnosed from the routine population as “alarming” and says:
“These patients are also potentially being disadvantaged by longer clinic waits and delays in diagnosis as waiting times for routine referrals have increased in the face of increasing service demands from the dramatically increased number of patients referred under the two week rule, over 90% of whom have benign disease.”
Despite increasing numbers of referrals, waiting times for the 2 week wait group were always well maintained say the authors. However waiting times for routine referrals increased, these patients currently have to wait 30 days.
They conclude by saying: “The system is failing patients and a change is urgently needed.”