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The Two Week Wait (2WW) study – an investigation of patient non-attendance at urgent referral appointments for suspected cancer

Since 2000 NHS patients with suspected cancer have been guaranteed to see a hospital specialist within two weeks of the GP requesting an urgent appointment, a so-called Two Week Wait (2WW) appointment. This policy is intended to shorten time to diagnosis and treatment, and ultimately improve survival rates; in general the later cancer is diagnosed, the lower the chance of cure and the shorter the survival period. In Leeds in 2015 more than 26,000 patients were referred under the 2WW policy – this has become a busy and significant referral pathway from primary to secondary care. On average 10% of 2WW referred patients receive a diagnosis of cancer. However in recent years 10-16% of 2WW referred patients in Leeds were not seen within two weeks, mostly because they did not attend, cancelled or postponed their appointment.

What will 2WW do?

This study will be completed in four phases, over 2016 - 2018:

Phase 1

• This phase will provide new knowledge on the NHS appointment categories of Did Not Attend (DNA) or Cancelled By Patient (CBP), to indicate the proportions not seen because they chose not to attend, and those who had died or were admitted to hospital before the appointment. ‘Cancellations’ will also be categorised into postponements and true cancellations.

Phase 2

• This study phase will look for factors associated with non-attendance or cancellation, including those associated with the patient (e.g. age, gender), the GP practice (e.g. deprivation, referral rate) and the suspected cancer type. 

Phase 3 

• Phase three will assess the consequences of non-attendance, by comparing rates of cancer diagnosis in those who do attend the 2WW referral and those who postpone or don’t attend. This will determine the impact of non-attendance at 2WW clinics on cancer outcomes.

Phase 4

• The final study phase will be qualitative, using interviews and discussion groups, to explore the views of patients and GPs on why patients do not attend 2WW urgent referral appointments.