Summary
| What is known? The UK 2-week wait (2WW) pathway for rapid access to cancer services has not been shown to be effective for diagnosis of suspected brain cancer. What is the question? Can the pathway be improved using evidence-based referral parameters? What individual signs and symptoms, or combinations thereof, can more accurately predict brain cancer? What was found? As the second largest 2WW cohort to date, identification of brain cancer remains low. The pathway is misused for rapid access for abnormal brain imaging done outside the service and for headache, the most common reason for referral. No individual or groups of signs or symptoms predicted brain cancer. Behavioural/personality change and sub-acute neurological deficit met the PPV 3% referral threshold, but there was no significant association between any criteria and brain cancer. What is the implication for practice now? Isolated headache is an unreliable indicator for brain cancer. Current evidence shows that early morning headache is not an indicator for raised intracranial pressure nor mass effect, yet headache remains the most frequent reason for referral. Guidelines should adhere to the existing clinical evidence; 2WW resources would be better directed towards prospective multicentre data collection, clinical research and treatment trials. |