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Rapid-access gynecological oncology clinic outcomes in North London, UK

Authors Bansal JK, Goldrick IG, Manchanda R, Olaitan A

Received 11 November 2016

Accepted for publication 4 April 2017

Published 7 June 2017 Volume 2017:9 Pages 19—23


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Marietta Stanton

Jassimran K Bansal,1,* Isabelle G Goldrick,1,* Ranjit Manchanda,2–4 Adeola Olaitan5

1Medical School, University College London, 2Barts Cancer Institute, Queen Mary University of London, London, 3Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, 4Gynaecological Cancer Research Centre, University College London, London, 5Department of Gynaecological Oncology, University College London Hospital, London, UK

*These authors contributed equally to this work

Abstract: The North London Gynaecological Cancer Network guidelines, based on Department of Health recommendations, state that women with lesions or symptoms suspicious of gynecological cancer should be referred to the rapid-access clinic (RAC) and see a specialist within 2 weeks. The appropriateness and clinical outcomes of these referrals were evaluated and compared with cancers diagnosed from other sources in the same hospital over the same time period. This was a retrospective review of RAC gynecological cancer referrals to University College London Hospital in 2012. Clinical and demographic details were collected from the Clinical Data Repository. Statistics were calculated with MeasuringU software. Among 335 women referred to the RAC, 14 (4.2%) had cancer. Most women had benign pathology (80.6%). This same year, 13 cancers were diagnosed elsewhere, including in the emergency department. A total of 172 referrals did not fulfill the guidelines. The apparent positive predictive value (PPV) for the referrals was 0.042. If appropriately followed, the PPV for guidelines would be 0.091. The apparent PPV of the current referral system for urgent gynecological cancers is low. Greater discretion in primary care and proper use of referral guidelines are required. Avoiding inappropriate referrals can double the PPV, leading to cost savings for the National Health Service.

Keywords: gynecology, general practice, 2-week wait, genital neoplasms, gynecological cancers

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