The 2-week wait referral system does not improve 5-year colorectal cancer survival

Colorectal Dis. 2012 Apr;14(4):e177-80. doi: 10.1111/j.1463-1318.2011.02826.x.


Aim: The aim of this study was to compare 5-year survival rates in colorectal cancer (CRC) patients who underwent potentially curative surgery before and after the introduction of the 2-week wait (2WW) referral system.

Method: Data were collected retrospectively from a prospectively maintained cancer database for CRC patients who underwent surgery in 1999 (pre-2WW group, n = 150) and 2002 (post-2WW group, n = 126). Patients who presented as an emergency, those who died within 30 days of surgery and those who presented with incurable CRC were excluded. We used the Kaplan-Meier method to plot survival curves and the log rank test to compare survival rates between the two groups.

Results: The 5-year survival rates in the pre-2WW and post-2WW groups did not differ significantly (71%vs 72%, respectively; P = 0.880). The number of CRC patients who presented via urgent pathways was higher in the post-2WW group than in the pre-2WW group (77%vs 38%, P < 0.001). Further, owing to this change in the referral pattern, the overall delay between referral and treatment was significantly lower in the post-2WW group than in the pre-2WW group (median 76 days vs 115, P = 0.009).

Conclusion: The 2WW referral system for patients with symptoms of CRC does not translate into improved survival. However, more patients with symptomatic CRC are being referred via urgent pathways.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Colorectal Neoplasms / mortality*
  • Colorectal Neoplasms / surgery
  • Elective Surgical Procedures
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Referral and Consultation*
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • United Kingdom
  • Waiting Lists*