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Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
  1. James Andrew Jones1,
  2. James Catton2,
  3. Glen Howard1,
  4. Paul Leeder3,
  5. Lesley Brewer4,
  6. James Hatton1,
  7. Dominick E Shaw1,2,5
  1. 1 East Midlands Academic Health Science Network, Nottingham, UK
  2. 2 Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3 Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
  4. 4 East Midlands Clinical Networks, Nottingham, UK
  5. 5 Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to James Andrew Jones; James.jones5{at}


Background Cancer survival in the UK has doubled in the last 40 years; however, 1-year and 5-year survival rates are still lower than other countries. One cause may be a delay between referral into secondary care and subsequent investigation. We set out to evaluate the impact of a straight to test pathway (STTP) on time to diagnosis for upper gastrointestinal (UGI) cancer.

Methods Six hospital Trusts across the East Midlands Clinical Network introduced a STTP enabling general practitioners to refer patients with suspected UGI cancer (oesophageal/gastric) for immediate investigation, without the need to see a hospital specialist first. Data were collected for all patients referred between 2013 and 2015 with suspected UGI cancer and stratified by STTP or traditional referral pathway. Overall time from referral to diagnosis was compared. Data from two Trusts who did not implement STTP acted as control.

Results 340 patients followed the STTP pathway and 495 followed the traditional route. STTP saved a mean of 7 days from referral to treatment (with a 95% CI of 3 to 11 days, p<0.008) and a mean of 16 days from referral to diagnosis, when compared with a traditional referral pathway. The number of diagnostic tests performed using STTP or traditional referral pathways were similar.

Conclusion A STTP is associated with an overall reduction of 1 week from referral to treatment for UGI cancer. The approach is feasible and did not require more resource. Larger studies are required to assess whether this time saving translates into improved cancer outcomes.

  • evaluation methodology
  • healthcare quality improvement
  • health services research
  • performance measures
  • statistics

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  • Contributors JAJ gathered and analysed the data, analysis and co-wrote the first draft. He is also guarantor for the paper. JC was co-clinical lead and helped design the project. GH provided analytical support for the results section. PL was the co-clinical lead and helped design and run the project. LB provided regional support. JH provided further analytical support for the results section. DES supported the analysis and co-wrote the first draft.

  • Funding This study was part of the Accelerate Communicate Evaluate (ACE) programme which was funded by Cancer Research UK.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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