Two-week rule in head and neck cancer 2000-14: a systematic review

The British Journal of Oral & Maxillofacial Surgery
Steve LangtonClare Bankhead

Abstract

The fast-track system in the UK for patients with suspected cancer--the two-week rule--states that if cancer is suspected there should be a maximum of 14 days between referral from primary care and consultation with a specialist. This approach is valued by patients, ensures a universal standard of diagnosis, and speeds up the overall management of cancer. However, some say that the rule has had little or no effect on survival, results in a diagnosis of cancer in only a small proportion of patients referred, and is expensive. We have made a systematic review of the effectiveness of the two-week rule in patients with head and neck cancer with the aid of electronic searches of databases. including MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews CINAHL, and CANCERLIT up to the end of 2014. This was supplemented by searching conference proceedings and contacting experts. Retrospective and prospective studies that included either conversion rate (proportion of two-week referrals who were diagnosed with cancer--positive predictive value), or detection rate (proportion of diagnosed cancers referred under the two-week rule - sensitivity), or both, were included. Two reviewers assessed studies for inclusion, and extracted da...Continue Reading

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