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Medical School Hot Topic: Two Week Wait Cancer Pathway
The two week wait cancer pathway is a two week referral system that has been in place in England for around 20 years. It allows the expedited referral of patients that GPs judge as having red flags for cancer, in order that they can receive hospital care - seeing an oncologist and having required tests and investigations performed. This does not mean treatment will be provided within that timeframe - merely that your first hospital appointment will be. The two week wait time is currently applicable only to England, although applies also to suspected breast cancer in Northern Ireland. Scotland and Wales do not have the system in place.
The two week wait pathway is popular with healthcare figures, and believed to have a very positive effect on patient outcomes - as seen by a review in 2010, that concluded that, ‘after careful consideration of a wide range of issues related to the current waiting time standards, the Advisory Group were unanimous in their view that these standards have been beneficial for patients, and that they should be retained without any changes at a national level.’
Example Interview Questions
- What is the two week wait cancer pathway?
- Is the two week wait cancer pathway beneficial for patients?
- Does the two week wait cancer pathway mean that you will begin treatment in just two weeks?
- Who is responsible for referring patients onto the two week cancer pathway?
- Roughly when might a patient expect to begin treatment after first presenting to their GP?
Interview Questions & Example Answers
What is the 2 week wait cancer pathway?
The 2 week wait cancer pathway is a 2 week referral system, in place in England for around 20 years. It allows GPs to quickly refer patients that have red flags for cancer, with the intention that they receive their first hospital appointment or investigation within two weeks. Whilst it is currently only applicable to England, Northern Ireland has a similar system in place for breast cancer. It should be noted that the 2 week wait does not mean that first treatment will be within 2 weeks - just that the first hospital visit will be. The pathway is popular with both doctors and patients.
Is the 2 week wait cancer pathway beneficial for patients?
The 2 week wait pathway was reviewed in 2010 and found to have a ‘very positive’ effect on patient outcomes. It was concluded that, ‘after careful consideration of a wide range of issues related to the current waiting time standards, the Advisory Group were unanimous in their view that these standards have been beneficial for patients, and that they should be retained without any changes at a national level.’ It therefore seems that the pathway is beneficial for patients.
Does the 2 week wait cancer pathway mean that you will begin treatment in just two weeks?
No, the pathway means only that you will receive your first hospital visit within 2 weeks - be that an appointment or investigation.
Who is responsible for referring patients onto the 2 week cancer pathway?
GPs have the responsibility for referring patients onto the pathway.
Roughly when might a patient expect to begin treatment after first presenting to their GP?
As it stands, NHS England is working on a new standard labelled the FDS, or Faster Diagnosis Standard. Through this, it hopes that patients will receive a result within 28 days of referral - two weeks after having their first test. They would then expect to start treatment within a month of their diagnosis. This results in a total time of two months from first presentation to the initiation of treatment.
What does a referral mean for the patient?
Some patients will fear that as they have been referred, they will almost certainly have cancer. However, over 90% of those referred under the urgent referral system will not be diagnosed with cancer. Referrals are provided by phone, post or email.
The referral might mean that the patient sees a specialist prior to getting tests (if needed), or they may be referred straight for tests.
The patient must not expect to receive information about the tests immediately after, and there may be a considerable wait until the test results can be delivered. Your results will be explained to the patient by the hospital specialist or their GP.
NHS England is working towards a new standard dubbed the FDS - Faster Diagnosis Standard. This attempts to guarantee a patient a result (whether or not they have cancer) within 28 days of their referral - i.e. around two weeks after their test itself. Again, this applies only to England. The patient would then expect to start treatment within a month of their diagnosis, making the total process from first presenting to their GP to initiation of treatment roughly two months. These times are variable, depending on the area that the patient lives in.
How are GPs approaching the referrals system?
Different GPs have different ways of dealing with patients who they refer on - some will explain that there is a potential risk of cancer, and this is the reason for their being referred. Others might neglect to mention the risk as the chance of cancer is so small, in order not to worry the patient. However, this approach carries significant risks with it - the patient will likely have organized the appointment due to fear of the underlying cause of their symptoms, and this fear will remain. In a survey conducted in 2010 of 160 patients, 49% of patients appeared to be unaware of their GP’s concerns when referred on, leading some patients to not attend their urgent appointment, or delay the appointment in order to prioritise other aspects of their life. Additionally, many patients will be shocked when the hospital contacts them, seeing that cancer is mentioned as part of the reason for their urgent referral. Therefore GPs should look to acknowledge the reason that the patient came to them, delicately explain that cancer is a differential diganosis, and explain that the system in place is designed to allow the fast assessment of all possible cancer cases- even though the majority will turn out to be false alarms. Therefore the patient will understand that the GP is giving due concern to their case, without labouring under the false impression that a referral under the two week wait system is tantamount to a cancer diagnosis.