A “waiting for investigation” index would be useful

Editor—Oliver raises the point that all stages of the cancer care pathway need speeding up, not just the time taken to see urgent referrals under the two week rule.¹ We are becoming increasingly concerned about the long delays that many patients experience while they wait for investigations needed before the most appropriate treatment can be decided.

The initial delay to see a hospital consultant, and the time spent on a waiting list for treatment, are nationally audited and familiar to patients, but the third wait—for investigations—is rarely acknowledged. We carried out a postal survey of hospital departments in the northwest of England and found disturbingly long waits for commonly requested investigations.

Over a third of the endoscopy and radiology departments that we contacted quoted waits of over two weeks for urgent tests in cases in which malignancy was suspected. Altogether 8% of such patients waited over four weeks. Waiting times for tests in cases in which malignancy was thought unlikely but needed to be excluded were longer, with a median of between four weeks and two months and some waits of over eight months. Patients waiting for investigations for benign disease with mild to moderate symptoms fared even worse, with a median wait of over two months and again some waiting over eight months. The waiting time for routine magnetic resonance imaging was over 11 months in one hospital.

In many cases the investigations are essential before treatment can proceed; clinicians have no choice but to delay until the results are known. In other cases, however, the investigations are helpful rather than essential. In these cases the clinician will face the dilemma of whether to proceed to treatment without the investigations, to order an alternative test that could be performed more quickly but would give less helpful results, or to delay treatment until the investigation of choice is done.

Limited resources might be more effective if spent on reducing waiting times for investigations rather than on implementing the two week rule. A “waiting for investigation” index, akin to the cost of living index, might be created to measure the performance of individual trusts and then aggregated into official waiting times for treatments.