1. Patients referred under UGI 2WW
Pilot direct access
Standard 2WW UGI
Study period
28th January 2016 –
25th May 2016
Number 2WW
UGI referrals
122
203
Mean age
[95% CI]
61.6 years
[58.3, 64.8]
66.4 years
[64.3, 68.5]
First contact allocated
OGD straight to test
Clinic first
55% (n = 67)
45% (n = 55)
30% (n = 60)
70% (n = 143)

2. Time to first contact at NUH: OGD
Pilot direct access
Standard 2WW UGI
Mean days from GP referral to
direct-to-test OGD
10.0
[95%CI 9.0, 10.9]
10.6
[95%CI 8.9, 12.2]
No difference between pilot
direct access and standard 2WW
p > 0.05

3. Time to first contact at NUH: clinic
Pilot direct access
Standard 2WW UGI
Mean days from GP referral to outpatient clinic
10.7
[95%CI 7.1, 14.3]
9.7
[95%CI 8.8, 10.5]
No difference between pilot
direct access and standard 2WW
p > 0.05

4. Time to first contact at NUH
Pilot direct access
Standard 2WW UGI
Mean days from GP referral to
direct-to-test OGD
10.0
[95%CI 9.0, 10.9]
10.6
[95%CI 8.9, 12.2]
Mean days from GP referral to outpatient clinic
10.7
[95%CI 7.1, 14.3]
9.7
[95%CI 8.8, 10.5]

5. Tests requested after clinic: standard UGI 2WW

6. Time on UGI 2WW pathway Time spent on UGI 2WW pathway
Pilot direct access
Standard 2WW UGI
Mean days from GP referral to ‘exit’ from UGI 2WW pathway

7. Time on UGI 2WW pathway Exit from UGI 2WW pathway may involve:
test(s) undertaken to diagnose patient’s symptoms
test(s) performed to exclude oesophago-gastric cancer

8. Time on UGI 2WW pathway Time spent on UGI 2WW pathway
Pilot direct access
Standard 2WW UGI
Mean days from GP referral to ‘exit’ from UGI 2WW pathway
16.9
[95%CI 14.9, 18.8]
16.8
[95%CI 15.4, 18.2]
No difference between pilot
direct access and standard 2WW
p > 0.05

9. Time on UGI 2WW pathway Time spent on UGI 2WW pathway
Pilot direct access
Standard 2WW UGI
Exit from UGI 2WW pathway if direct-to-test OGD is 1st contact
11.6
[95%CI 10.3, 12.9]
12.0
[95%CI 9.7, 14.3]
Exit from UGI 2WW pathway if clinic is 1st contact
23.8
[95%CI 20.8, 26.9]
19.1
[95%CI 17.4, 20.7]
Quicker exit time from UGI 2WW pathway if only
contact is straight-to-test OGD
-> Caveat: test to exclude OG cancer

10. Time on UGI 2WW pathway Time spent on UGI 2WW pathway
Pilot direct access
Standard 2WW UGI
Exit from UGI 2WW pathway if direct-to-test OGD is 1st contact
11.6
[95%CI 10.3, 12.9]
12.0
[95%CI 9.7, 14.3]
Exit from UGI 2WW pathway if clinic is 1st contact
23.8
[95%CI 20.8, 26.9]
19.1
[95%CI 17.4, 20.7]
Quicker exit from UGI 2WW pathway
along standard UGI 2WW
p < 0.05

11. Time on UGI 2WW pathway Time spent on UGI 2WW pathway
Pilot direct access
Standard 2WW UGI
Mean days from GP referral to ‘exit’ from UGI 2WW pathway
16.9
[95%CI 14.9, 18.8]
16.8
[95%CI 15.4, 18.2]
Exit from UGI 2WW pathway if direct-to-test OGD is 1st contact
11.6
[95%CI 10.3, 12.9]
12.0
[95%CI 9.7, 14.3]
Exit from UGI 2WW pathway if clinic is 1st contact
23.8
[95%CI 20.8, 26.9]
19.1
[95%CI 17.4, 20.7]

12. Cancer diagnoses UGI 2WW pathway
First contact
Mode of presentation
Pilot pathway
Direct-to-test OGD
Post-prandial vomiting, weight loss
Weight loss
Dyspepsia
Pancreas cancer?
Bowel cancer
Pancreas cancer
Clinic first
Known ovarian cancer, known mediastinal disease, dysphagia
Metastatic prostate cancer
Progressive ovarian cancer

13. Cancer diagnoses UGI 2WW pathway
First contact
Mode of presentation
Standard 2WW UGI
Direct-to-test OGD
Dysphagia
Localised oesophageal CA
Clinic first
Dysphagia, bowel cancer surgery 2015
IDA, previous colonic adenoma
Dysphagia with N OGD 2015
IDA
Post-prandial vomiting, weight loss
Weight loss, anorexia
Weight loss with N OGD 2016
Dysphagia with SCC mouth 2004
Dysphagia with SCC palate and schizophrenia++
Weight loss with schizophrenia ++
Weight loss, vague abdominal pain
IDA, post-prandial vomiting
Obstructed metastatic bowel cancer from localised occurrence
Localised bowel cancer
Metastatic thymoma
Metastatic bowel cancer
Metastatic duodenal cancer
Metastatic pancreas cancer
Metastatic SCC ?oeso ?orophar
Metastatic SCC ?oeso ?palate
Localised pancreas CA
Metastatic stomach cancer

14. Cancer diagnoses post-exit from UGI 2WW pathway
First contact at NUH
Mode of presentation
1 month post-exit standard 2WW UGI
Direct-to-test OGD
Dysphagia with N OGD [no chest imaging]
Metastatic pancreas CA with lung metastases
[emergency admission]
Clinic first
Abdominal pain with N OGD
Iron def anaemia, failed CT colonography
Ascending bowel cancer
[re-referral C+B Gastro]
Obstructed caecal bowel cancer

15. Complications post-exit from UGI 2WW pathway
Days post-UGI 2WW pathway exit
Complication 3
Emergency admission with aspiration pneumonia post-OGD, then had acute stroke day 12 of hospitalisation 7
Emergency admission with ARF requiring haemodialysis precipitated by [cardiac] ascites drainage 20
Emergency admission with pancytopenia presenting with symptomatic anaemia 5
Emergency admission with decompensated heart failure following OGD

16. Death post-exit from UGI 2WW pathway
Days post-UGI 2WW pathway exit
Diagnosis given at exit from UGI 2WW pathway 48
Metastatic SCC oesophagus with peritoneal disease 39
Metastatic pancreas cancer with liver, peritoneal and skin metastases 30
Metastatic SCC oesophagus with liver infiltration

17. Emergency presentation resulting in a diagnosis of cancer at NUH in 2014
Number of cancers diagnosed following
emergency admission to NUH
Postcode

18. Postcode distribution?
Proportion %

19. Conclusions
Vetting at hospital stage is not rate limiting step in exit from pathway

20. Conclusions
Vetting at hospital stage is not rate limiting step in exit from pathway
Cancers identified by GP-requested DTT OGD were not oesophago-gastric but required further tests

21. Conclusions
Vetting at hospital stage is not rate limiting step in exit from pathway
Cancers identified by GP-requested DTT OGD were not oesophago-gastric but required further tests
UGI 2WW pathway more frequently diagnoses cancer outside of oesophago-gastric tract [which cannot be diagnosed by OGD alone]

22. Conclusions
Vetting at hospital stage is not rate limiting step in exit from pathway
Cancers identified by GP-requested DTT OGD were not oesophago-gastric but required further tests
UGI 2WW pathway more frequently diagnoses cancer outside of oesophago-gastric tract [which cannot be diagnosed by OGD alone]
There is a postcode variation in 2WW suspected cancer referrals and emergency cancer diagnoses but this is complex

23. Conclusions
Vetting at hospital stage is not rate limiting step in exit from pathway
Cancers identified by GP-requested DTT OGD were not oesophago-gastric but required further tests
UGI 2WW pathway more frequently diagnoses cancer outside of oesophago-gastric tract [which cannot be diagnosed by OGD alone]
There is a postcode variation in 2WW suspected cancer referrals and emergency cancer diagnoses but this is complex

24. Nina R Lewis nina. lewis@nuh. nhs
Nina R Lewis Extension Fax: