Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.752020
Title: Upper gastrointestinal cancer : do our clinical services work towards the 'two week rule' and how?
Author: Gheorghiu, Serban Ioan
Awarding Body: University of Wales, Swansea
Current Institution: Swansea University
Date of Award: 2006
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Abstract:
The present research work investigates the results observed in the management of those patients diagnosed with Upper Gastro-Intestinal Cancers subsequent to the use of algorithms of referral and clinical services such as Open Access Endoscopy and Rapid Opinion Clinic. This is a retrospective analysis based on the auditing methodology which looks to the experience gained in two NHS Trust hospitals in South Wales over a period of six calendar years. An uncensored cohort of 440 patients diagnosed with various forms of Upper Gastro-Intestinal cancers are examined and their referral pathway, positive diagnosis, investigation and staging, as well as treatment and 5-year follow up is analyzed. The traditional methods of referring patients from the Primary Care sector are compared with the new open-access type of clinical services such as Open Access Endoscopy and Rapid Opinion Clinic in the context of the "two week rule" for cancer referral. It has been found that using the open access services the median delay for appointments is reduced to 11 days which is below the required threshold imposed by The NHS Cancer Plan. The mean GP delay interval remains slightly higher at 17.09 days mainly due to cases with atypical clinical picture; the same applies to the mean treatment delay which at 44.43 days is related with the staging investigations. The results of these referral methods are also discussed from the perspective of patients' outcome as a measure of the benefits gained through the introduction of these clinical services. It has been noted that the rate of newly diagnosed early stage cancers has not increased and there was no gained benefit in diagnosing patients with more favourable stage of the disease. There was a hint that patients diagnosed through Open Access Endoscopy may have a less advanced disease with a higher rate of operability and a smaller benefit in survival probability. This study concludes that new open-access style clinical services backed up by clear referral algorithms may increase the speed of patients' appointments and diagnosis in the Secondary Care sector but there is only little clinical and statistical evidence of benefits such as early cancer detection, operability and survival probability. Areas of improvement in referral algorithm such as the combination of "alarm symptoms", exclusion of uncomplicated dyspepsia as a referral criterion in young adults, pooling all patients at risk with gastroenterological symptoms under the open access style of referral and stream lining of the staging and treatment pathway are amongst recommendations made at the end of this study.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.752020  DOI: Not available
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