Two-week target 'changing little' for breast cancer patients

Cancer Research UK

The Government's two-week target is failing to have the hoped-for impact on waiting times for breast cancer treatment, according to a study published in the British Journal of Cancer1.

The target - set in April 1999 - aims for all women referred urgently by their GP with suspected breast cancer to see a hospital consultant within a fortnight. But nearly two years later, while the proportion of women meeting the target had risen, waiting times for subsequent treatment had gone up and overall waiting times had not changed.

Radiotherapy patients in particular often face unacceptable waits for treatment, according to the report. It also found that women with symptoms of breast cancer generally wait longer for an appointment than those diagnosed through screening, even though their cases may be more urgent.

Researchers at the Thames Cancer Registry, King's College London, examined audit data on waiting times from 19 hospitals in South East England. The study analysed the records of 5750 women referred by their GP between July 1997 and December 2000 and treated for breast cancer in subsequent months, comparing those referred before and after the April 1999 watershed.

Following the introduction of the target, the proportion of women who saw a consultant within two weeks of referral rose from 66 per cent to 75 per cent, while the median (midpoint average) waiting time fell from 11 to 10 days.

But the proportion of women who received treatment within five weeks of their hospital appointment fell from 84 per cent to 80 per cent and median waiting time increased from 16 to 20 days.

Researchers found that waiting times for treatment depended on the type of treatment being waited for. Of women who had tamoxifen for their first treatment, 95 per cent received treatment in the five-week period, compared with 81 per cent of those waiting for chemotherapy, 77 per cent waiting for surgery and just 53 per cent of patients awaiting radiotherapy as their first treatment.

Dr David Robinson, of Guy's, King's and St Thomas' School of Medicine, King's College London, says: "Our study suggests that the Government's two-week target has changed little for women undergoing breast cancer treatment. The problem with arbitrary targets is that rather than bringing about a genuine and lasting improvement in cancer services, they just seem to push patients from one queue to another."

The two-week target was met more often for women whose cancers were detected by the screening programme than for those who went to their doctors with symptoms of cancer.

A total of 86 per cent of women with screen-detected tumours saw a consultant within two weeks, but that figure fell to just 68 per cent for women with symptoms.

Doctors believe that some symptomatic women may be referred non-urgently by their GPs, and that waiting times for non-urgent referrals may be increasing as consultants concentrate on meeting their targets for urgent referrals.

Dr Robinson adds: "The effects we have observed reflect the risks inherent in a policy of targeting one element of the patient pathway in isolation."

Professor Robert Souhami, Cancer Research UK's Director of Clinical Research, says: "The NHS Cancer Plan is a great idea, but it's got a long way to go before it becomes a successful reality.

"We have to look beyond arbitrary targets and headline figures to the complete and complex picture of cancer care, so we can properly evaluate progress and highlight the areas that most urgently need improving.

"While we'd agree women should have a hospital appointment within a fortnight of referral, it's an achievement that's undermined if they then have to wait more than five weeks for treatment, as almost half of women needing radiotherapy are having to do now."

  • Also in today's British Journal of Cancer, scientists from Cancer Research UK report that patients who have been treated by specialist breast surgeons have a significantly improved chance of long-term survival. Patients treated by specialists were also more likely to receive chemotherapy, suggesting that they are given better access to multidisciplinary teams of doctors.

ENDS

  1. British Journal of Cancer89 (3)