163 Is the current 2 week wait cancer referral (2WW referral) fit for purpose in malignant brain tumour referrals?

Abstract

The 2WW pathway aims to ensure timely assessment of patients following referral from primary care with suspected malignant tumours of brain and central nervous system. NICE guidance CG121 is designed to avoid inappropriate referrals, delays and to reduce patient anxiety avoiding longer waits. This audit evaluated compliance of referrals in 2WW pathway at South Tees NHS Foundation Trust and assessed the appropriateness of referrals submitted to the multidisciplinary team (MDT). Details of 47 neuro-oncology 2WW referrals submitted over 1 year and 10 months were retrospectively reviewed. Referral forms and electronic medical records were analysed to assess documentation, MRI completion, patient information regarding urgent referral, MDT discussion timelines, and appropriateness of referral for cancer tumour. Of 47 referrals, 46 were submitted using the correct form. 93.4%(43) of patients were informed about the urgent referral and 97.9%(46) were discussed at MDT within two weeks. However, only 10.5%(5) of referrals were accepted as appropriate 2WW cases. Most rejected referrals involved benign conditions, many of which were described as benign or incidental on radiology reports; yet referred as 2WW cancer referral. One referral was also made without imaging. While administrative compliance and MDT timeliness were high, inappropriate use of the 2WW pathway was identified. Unnecessary patient anxiety, increasing workload for MDT and straining clinic appointment needs were clearly evident. Recommendations from the audit were for consideration of leaflets to be sent to primary care centres clarifying the validity of referrals via 2WW pathway and suggestion to avoid referring certain tumour types in radiology report under this pathway. There may also be a role in radiology reports to specify “benign”, but implementation may be difficult due to outsourcing of reporting.