The two-week rule in colorectal cancer. Can it deliver its promise?

Despite recent advances in technology, a high percentage of patients with colorectal cancer present with disease that is already advanced, leading to an overall 5-year survival rate of 49.6% in men and 50.8% in women. In order to facilitate access to specialist cancer units, across specialities, the Department of Health formulated the NHS Cancer Plan in 2000 which consisted, in part, of the 'two-week rule' (TWR). The TWR was launched to ensure that all patients meeting specific referral criteria for suspected colorectal cancer were seen by a hospital specialist within 14 days of referral. The TWR referral system was set up with the intention of identifying 90% of patients with bowel cancer for prompt treatment. This study was conducted to investigate the difference in presentation between patients referred via the TWR pathway compared to those referred via an elective (non-TWR) route and to examine the impact of these referral routes on the time to treatment and clinical outcome.