Waiting lists are putting patients' lives in jeopardy

EDITOR—Spurgeon et al's findings on waiting times in England for patients with cancer are worrying to say the least.1 Nevertheless, the authors understate the problem because they take no account of delays before referrals by general practitioners.

In my experience the main cause of delay in patients with cancer receiving the treatment they need is delay in obtaining the necessary investigations, even when they are marked “urgent.” For example, in my area, suspected cases of bowel cancer take about four months to investigate—a four week wait for a sigmoidoscopy and a 12 week wait for an “urgent” barium enema. If patients need a colonoscopy the wait is longer still. By contrast, once these cases are diagnosed, they are usually seen by general surgeons within two weeks and wait no more than another two weeks for surgery.

More worrying still are patients with cancer who present with apparently benign symptoms and physical signs and who have to wait many months because they go on the non-urgent waiting list for investigation. I can recall one patient who clinically seemed to have gall stones but who eventually proved to have a primary hepatoma, and another patient who had persistent heartburn while taking low dose aspirin who had carcinoma of the stomach.

The mere fact that a clinician requests an investigation usually implies a degree of diagnostic uncertainty. Therefore, it follows that it is unsafe to put patients on waiting lists for investigations …