Diarrhea After Hematopoietic Stem Cell Transplantation Is Not Simplified

alternative to CCY, and patients with ABP admitted to centers with high ERCP volume are also less likely to receive CCY. Likelihood of CCY for ABP based on volume of total CCY, pancreatitis admissions, and ERCPs W1031 UK Fast-Track Referral Criteria for Suspected Oesophageal, Gastric, Pancreatic and Hepatobiliary Cancers Do Not Improve One-Year Survival Rates Sarah L. Addis, Alexander C. Ford, Sulleman Moreea Background: The fast-track (FT) referral criteria for suspected upper gastrointestinal (UGI) malignancy were introduced in the UK in 2000 to detect and treat cancers at an earlier stage with the aim of improving survival.A proposed national audit of their efficacy has never been conducted.Aims: We prospectively compared outcomes of UGI malignancies detected in FT referrals with those diagnosed via conventional referral routes.Methods: We obtained data from clinical notes and mortality office records, as well as the registry of our regional multidisciplinary meeting where all cancer cases, independent of their route of referral, are discussed.One-year survival rates of confirmed UGI malignancy among all FT referrals offered curative treatment were compared with those diagnosed and treated via conventional routes using an odds ratio (OR) and 95% confidence interval (CI).Results: Between June 2006 and May 2007 there were 483 (209 males [43%]) FT referrals for suspected UGI cancer.Malignancy was confirmed in 46 (9.5%) of these: 22 oesophageal (O), 14 gastric (G), 5 pancreatic (P), and 5 hepatobiliary (HB) in 28 males (mean age 68yrs, 13% of all males) and 18 females (mean age 74yrs, 6.5% of all females).In the non-FT group there were 103 confirmed cancers (18 O, 33 G, 32 P and 20 HB) in 60 males (mean age 72 yrs) and 43 females (mean age 71 yrs).Potentially curative treatment was carried out in 13 of the FT group, the remainder received palliative therapy.One-year survival in the curative treatment group was 23% (3/13).Curative treatment was offered to 23 of the non-FT group, with 15 (65%) alive at one-year follow-up.There was a significantly reduced one-year survival in FT patients offered curative treatment compared to those treated in the non-FT group (OR for survival = 0.16; 95% CI 0.03 -0.76, P = 0.02).Conclusion: Survival was reduced in FT referrals with suspected UGI cancer offered curative treatment, compared to those diagnosed and treated via conventional referral routes, suggesting that current FT referral criteria are identifying those with advanced malignancy.This is an example of leadtime bias, with an earlier diagnosis, but no improvement in survival.In addition, directing scarce resources towards FT referrals may be compromising outcomes in those diagnosed with UGI cancer via conventional routes.