Using data from the breast unit at King’s College Hospital, the team examined all general practitioners’ referrals to the breast clinic between April 1999 and December 2000. Altogether 3,597 referrals were made, 665 were marked as urgent and 2,932 as non-urgent. Sixty-two urgent patients and 49 non-urgent patients were subsequently found to have breast cancer.
It is evident that the two week wait initiative is not ensuring that most patients with symptomatic cancer are seen within two weeks of referral, say the authors. The emphasis on seeing urgent cases within the time has been at the expense of the non-urgent cases. Waiting times in this group have increased to 12 weeks in some units.
“By grading patient referrals, we are creating a two tier structure, with patients in the non-urgent group waiting longer periods for diagnosis and treatment. For patients with cancers in this group the delay can be critical,” they argue.
As no grading system is perfect, the only way of guaranteeing that all patients with breast cancer are seen within two weeks is by seeing all the referrals in this period. This has become achievable at our unit through managing capacity and demand, they conclude.