Introduction
Health and economic impact
Stage | Men (%) | Women (%) |
---|---|---|
Stage I | 94.6 | 100.2 |
Stage II | 83.5 | 85.9 |
Stage III | 62.6 | 62.7 |
Stage IV | 6.9 | 8.1 |
All stages | 58.2 | 61.1 |
Stage not known | 18.7 | 15.1 |
Two-week wait referral
Objectives
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Primary outcomes
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What is the proportion of patients investigated for suspected colorectal cancer via the England and Wales TWW system, who are later diagnosed with colorectal cancer (cancer conversion rate)?
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What is the colorectal cancer stage at diagnosis?
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What is the effect of the TWW system on the mortality due to colorectal cancer?
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Secondary outcomes
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What is the proportion of patients diagnosed with a cancer outside of the colorectum who are referred via TWW with suspected colorectal cancer, and what site is affected?
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What proportion of patients are meeting the TWW time targets (i.e. proportion of patients seen within 14 days of referral, diagnosed within 31 days of referral and started treatment within 62 days of referral)?
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Methods
Study eligibility
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Inclusion criteria
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Study design: Prospective or retrospective cohort studies, case-control studies, cross-sectional studies.
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Study setting: Hospital- or community-based studies conducted in the UK.
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Population: Patients 18 years or older with signs or symptoms suggestive of lower gastrointestinal cancer as dictated by the NICE guidance for cancer referral from primary care (NG12).
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Intervention: TWW cancer referral system. Studies reporting data on multiple speciality referrals via TWW will be included if it is possible to separate outcome data by speciality to enable extraction of the colorectal cancer data only.
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Comparator: Any comparator used by an individual study providing data on colorectal cancer detection, stage and/or mortality (e.g. referral via non-TWW system, ‘routine referral pathway’, first presentation of colorectal cancer via emergency admission and possibly the bowel cancer screening population). Studies with TWW data, but without a comparator arm will also be included.
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Outcome: Rate of diagnosis, stage at diagnosis and/or mortality from colorectal cancer. Studies which include data on secondary outcomes without primary outcome data will be included.
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Timing: Any length of follow-up.
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Language of publication: English only.
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Date of publication: Eligible studies published in the year 2000 or onwards to correspond with implementation of the TWW referral system.
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Type of publication: Full-text reports.
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Exclusion criteria
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Population: (a) Patients with suspected cancer other than colorectal, (b) anal cancer cases, (c) participants aged <18 years and (d) pregnant women.
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Intervention/comparator: Non-TWW referral system (e.g. urgent referral, routine referral only). Non-UK-based studies.
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Outcomes: Studies not including data on any of the three primary outcomes (colorectal cancer diagnosis, stage and/or mortality) or secondary outcomes.
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Publication type: Reviews, editorials, letters, books, consensus statements or opinions. Review articles will be examined for identification of original studies but will not be included if they contain no primary data.
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Search strategy
Data management and study selection
Data extraction
Primary outcomes
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The rate of colorectal cancer diagnosis in patients referred through the TWW system
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Colorectal cancer stage at diagnosis (the staging system used will be determined by each individual study as it is anticipated the system used will vary between studies)
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Colorectal cancer related mortality amongst subjects referred and diagnosed via TWW
Secondary outcomes
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Other diagnosis made via the 2-week wait referral system except colorectal cancer
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Adherence to referral time frame protocol (e.g. seen by specialist within 14 days of referral)