A review of the electronic two-week rule referrals for head and neck cancer to Western Sussex Hospitals NHS Foundation Trust

Introduction The two-week rule (2WR) for referring suspected malignancies aims to improve access and outcomes for cancer patients. However, there has been criticism of the rule in the literature. GDPs have an important role in spotting head and neck cancer (HNC) and using the 2WR appropriately to ensure their patients get fast and effective treatment. Aims 1) To evaluate adherence to guidelines of electronic 2WR referrals for HNC sent to Western Sussex Hospitals Trust from GDPs in Sussex; 2) to determine the detection rate of oral malignancies from these referrals; 3) to determine the success of the maxillofacial unit in seeing referred patients within two weeks. Materials and methods Two hundred and nineteen randomised electronic 2WR referrals were analysed for adherence to the guidelines for referral of suspected oral cancer. Patient waiting times, subsequent correspondence and pathology results were analysed. Results One hundred and thirty-five referrals (62%) were deemed to be compliant with the NICE NG12 guidelines, while 186 referred patients (85%) were seen within the two-week time frame. Six referrals (2%) resulted in a positive detection of malignancy (a lower rate compared to similar previous studies). Discussion There are several possible reasons for the poor rate of guideline adherence from GDPs, such as pressure to refer defensively and a lack of knowledge of referral guidelines or oral pathology. This may contribute to a poor detection rate, although there may be other contributing factors. Conclusions Thirty-eight percent of electronic 2WR referrals from GDPs were deemed inappropriate; ongoing education is required to minimise these inappropriate referrals. Patients must be made aware of the reason for their referral to promote attendance. Further studies are required to identify the reasons for such a low detection rate.