Mozdiak Ella, Tsertsvadze Alexander, McFarlane Michael, Widlak Monika, Tabuso Maria, Dunlop Amber, Arasaradnam Ramesh
Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Syst Rev. 2016 Oct 26;5(1):182. doi: 10.1186/s13643-016-0358-6.
Colorectal cancer represents the fourth most common cancer in England and Wales; survival is high for early stage disease but declines sharply with advanced stage. UK figures suggest that cancer survival rates are lower than those of other Western European countries. Current 5-year survival is around 50 %. A rapid access strategy was introduced through the Department of Health in 2000. This 2-week wait (TWW) referral pathway was devised to streamline referral for suspected cancer, allow diagnosis at an earlier stage, reduce cancer survival inequality and reduce cancer-related mortality. However, only around half of patients with colorectal cancer have symptoms that fit the TWW criteria plus there is a fourfold difference in referral rates across England and Wales. High-quality evidence of TWW outcome measures for colorectal cancer is lacking. This systematic review will collate and evaluate the latest evidence on colorectal cancer detection rate, stage at diagnosis and mortality.
English-language publications from 2000 reporting outcomes on the TWW referral system for suspected colorectal cancer will be eligible for inclusion. Cochrane, EMBASE, MEDLINE via PubMed, NHS Evidence, Trip and the British Library Catalogue databases will be searched. Two paired reviewers will independently screen all titles/abstracts and full text for eligibility, then extract data and assess for bias using standardised formats. They will hand review reference lists of eligible articles. Disagreement will be resolved via third party adjudication. Summary effect measures for post-referral diagnosis and mortality rates will be calculated and expressed as relative risk, hazard rate ratio or risk difference with corresponding 95 % confidence intervals. Where possible summary effect measures will be pooled, heterogeneity and its extent for pooled estimates will be assessed via visual inspection of forest plots and explored via sub-group analysis.
In this systematic review, we aim to summarise the relevant evidence on cancer detection rate, cancer stage at diagnosis and disease-related mortality rates for patients with suspected colorectal cancer investigated through the TWW referral system in England and Wales. We will highlight gaps in the evidence and provide a better understanding of whether it is meeting its desired effect.
PROSPERO CRD42016037368.
在英格兰和威尔士，结直肠癌是第四大常见癌症；早期疾病的生存率较高，但随着病情进展会急剧下降。英国的数据表明，癌症生存率低于其他西欧国家。目前的5年生存率约为50%。2000年，卫生部推出了一项快速通道策略。这条两周等待期（TWW）转诊途径旨在简化疑似癌症的转诊流程，实现更早诊断，减少癌症生存率的不平等，并降低癌症相关死亡率。然而，只有约一半的结直肠癌患者有符合两周等待期标准的症状，而且英格兰和威尔士各地的转诊率相差四倍。缺乏关于结直肠癌两周等待期结果指标的高质量证据。本系统评价将整理和评估有关结直肠癌检出率、诊断时分期和死亡率的最新证据。
2000年以来报告疑似结直肠癌两周等待期转诊系统结果的英文出版物将符合纳入标准。将检索Cochrane、EMBASE、通过PubMed检索的MEDLINE、NHS证据库、Trip数据库和大英图书馆目录数据库。两名配对的评审员将独立筛选所有标题/摘要和全文以确定是否符合纳入标准，然后提取数据并使用标准化格式评估偏倚。他们将人工查阅符合条件文章的参考文献列表。分歧将通过第三方裁决解决。将计算转诊后诊断和死亡率的汇总效应量，并表示为相对风险、风险比或风险差以及相应的95%置信区间。如有可能，将汇总汇总效应量，通过森林图的视觉检查评估汇总估计的异质性及其程度，并通过亚组分析进行探讨。
在本系统评价中，我们旨在总结通过英格兰和威尔士的两周等待期转诊系统调查的疑似结直肠癌患者的癌症检出率、诊断时癌症分期和疾病相关死亡率的相关证据。我们将突出证据中的差距，并更好地了解该系统是否达到了预期效果。
PROSPERO CRD42016037368。
