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CAMHS won't see you now

GI Ca guide cuts referral 40%

A new risk score could throw a lifeline to overstretched endoscopy services by dramatically cutting GP referrals for suspected upper gastrointestinal cancer.

Researchers found the scoring system, which applies additional criteria on top of NICE guidelines, accurately predicted cancer while cutting referrals by 40 per cent.

Their study came as further research added to the evidence that the two-week rule is putting endoscopy services under intolerable pressure.

The researchers developed the risk score after assessing by questionnaire 402 patients attending first-time endoscopy.

They identified four positive indicators of cancer ­ age,

retrosternal dysphagia, shorter duration of abdominal pain and pain worsening (see box, right).

The score screens out patients who do not fit these

criteria ­ such as those who have suffered abdominal pain for six months or more without symptoms worsening.

Mr David Cade, researcher on the study and consultant surgeon at Leighton Hospital in Crewe, said: 'We have got a huge problem; we are being inundated with patients being sent down the two-week pathway and a lot of patients that can be dealt with in general practice.

'The NHS guidance is not sensitive enough. What we have got is far superior.'

The score predicts upper GI cancer with an accuracy rated at 0.87 on a scale where 0.8 is good and 0.9 is excellent.

Although it needs to be validated in a larger group of patients, the researchers hope to use it to develop a computer program to support GP decision making.

The team have already developed a similar program for colorectal cancer which is being used in Wales.

Dr Murray Freeman, cancer lead for Birkenhead and Wallasey PCT and a GP in Birkenhead, said: 'If there was some sort of algorithm for upper GI cancer I would welcome it, anything that would improve diagnosis would be useful. It would be especially helpful if it could be embedded into our computer systems.'

The research was presented at the British Society of Gastroenterology annual meeting in Birmingham alongside two studies heaping further criticism on the two-week rule.

Researchers found it increased workload without improving survival or greatly increasing detection rate for upper GI cancer.

Indicators to help with referral

Positive predictors

· Age

· Retrosternal dysphagia

· Abdominal pain for less than

six months

· Worsening abdominal pain

Negative predictors

· Female

· Abdominal pain for longer

than six months and not progressive

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