The Two-Week-Wait Referral Pathway: Not Fit for Purpose

Abstract AIMS The two-week-wait (2WW) referral pathway was set up by the Department of Health to improve early diagnosis and overall survival of cancer. Brain tumours, however, present with non-specific neurological symptoms. As such, this study set out to evaluate the efficacy of the 2WW pathway in detecting brain cancer in patients referred by primary care. METHOD Data from 217 patients referred via the 2WW pathway from January to September 2021 were extracted retrospectively, using the electronic health record system within the University College London NHS Foundation Trust. Details of the diagnoses, imaging results, and follow-up treatments were analysed. RESULTS Of the 217 patients referred with a suspected brain tumour, 0 patients received a new diagnosis of brain cancer. However, 4 cases of benign tumours were newly diagnosed through the 2WW pathway, with an additional 17 cases of benign tumours being referred for further management, having been detected on previous external imaging. 9 cases of known malignant brain tumours were referred for on-going management, having been treated previously elsewhere. CONCLUSION The 2WW pathway does not detect new cases of brain cancer. It is rather being used as a means of rapid referral of patients in primary care with benign tumours or previously identified brain cancer. This study therefore suggests that the initial aspiration of detecting brain cancer earlier via this pathway has not been fulfilled, but it is a useful tool for GPs to refer patients with brain tumours into Neuro-oncology services.