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At the heart of general practice since 1960

Our action plan over complaints

By Daniel Cressey

The Government's keystone two-week rule on cancer referral does not save lives and may increase waiting times, a comprehensive review of audit data concludes.

A leading cancer expert called for the scheme to be scrapped after the review of 35 studies found 'no evidence the initiative impacts on survival'.

The researchers, writing in the International Journal of Clinical Practice, urged ministers to consider alternative targets on waiting times for diagnosis or treatment.

Study leader Mr Stephen Hanna, specialist registrar at Leeds General Infirmary, said: 'Increased waiting times for other appointments have been noted and this has raised fears that the target may actually be leading to a delay in diagnosing cancers in many patients.'

'It is unlikely improvements in mortality will be seen until a co-ordinated approach is adopted,' he said.

In an accompanying editorial, Professor Ian Fentiman, professor of surgical oncology at Guy's Hospital, London, said: 'At an organisational level it would be better if the two-week rule was scrapped and all symptomatic patients seen within this time.'

Dr Cliff Richards, cancer lead for Runcorn PCT, said: 'Whatever we were doing in the past we were getting the patients to be investigated fairly quickly. There are now systematic delays because of the two-week wait. People who are fast-tracked are fine but the guidelines up to now haven't been sensitive enough.'

Dr Murray Freeman, cancer lead at Birkenhead and Wallasey PCT, said: 'It's concerning. On the one hand the two-week rule has put into place a system that gets people into [the system] in two weeks. The problem is the pick-up rates are very low. It's not sensitive or specific enough.'

But Dr Nick Brown, a GP in Chippenham and cancer lead for Kennet and North Wilts PCT, said although it had no impact on survival the programme had an important role in giving quick answers to anxious patients.

The Department of Health said: 'The two-week wait is not solely about improving survival rates. It is also about ensuring patients do not suffer the anxiety of waiting for weeks on end to find out whether or not they have cancer.'

Concerns over two-week rule

· Breast: Concerns raised over inappropriate referrals

· Gastrointestinal: 'Low yield of malignant diagnoses'

· Head and neck: 'Very low yield' for malignant pathology in the two-week wait patients

· Lung: 'High rate of adherence' to referral guidelines

IJCP 2005;59:1334-9

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