TWO-WEEK WAIT REFERRALS FOR CNS CANCER-ARE THEY WORKING?

Concerns about validity of the 2 week wait referral criteria for CNS cancers have been raised in the past. In 2005 a systematic review of cancer 2 week wait referrals across various specialties found only one suitable audit on CNS cancer, with low pick up rate ( Methods Seventy case notes of patients referred between May and August 2010 to the Walton Centre in Liverpool as 2 week wait referrals were reviewed, reasons for referral validated against referral criteria based on NICE Guidelines and the appropriateness of the referrals reassessed. Forty-eight case notes were independently examined by a second assessor and kappa statistic was calculated. Results Eight patients (11%) were diagnosed to have a CNS tumour of which five (7%) turned out to be malignant. Of the eight patients, diagnosis was known in five patients before referral, giving a pick-up rate for new CNS tumours of only three (4.6%) from the 2 week referrals. By application of 2 week wait referral criteria in retrospect, 58 out of 70 referrals (82%) did not fulfil the criteria, including three patients who were diagnosed to have cancer. There was inter-rater agreement on adherence to criteria in all but two cases (Kappa statistic=0.83). The criteria were found to have low sensitivity (0.62) and positive predictive values (0.41), undesirable for a screening test, but better specificity (0.89) and negative predictive value (0.95). Conclusions Pick-up rates for new cancers using current 2 week wait referral criteria are very low. Revision of the current criteria is needed.