An article published in the New Zealand Medical Journal this week, The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board, found that the majority of patients diagnosed with colon or rectum cancer (CRC) were not fast-tracked.

The research suggested that the criteria for a patient to be fast-tracked for suspected CRC needed to be re-examined and improved.

The Ministry of Health provides guidelines for symptoms that raise a High Index of Suspicion (HIS) for CRC and if GPs refer patients with HIS then they should have a fast track diagnosis within two weeks.

The referral information of 181 patients who were subsequently diagnosed with CRC were examined in the audit and only 36 per cent met the criteria to be fast-tracked.

The research concluded that the HIS Urgent pathway needed to be reviewed due to such a small percentage of patients meeting the criteria.

“GPs frequently failed to recognise and refer those who met the criteria. A standardised referral form prompting the inclusion of all required information would improve this.”

A New Zealand Medical Association spokesperson said the research suggests that the HIS criteria are too strict and a national referral form which prompted a GP to include all the essential information might then facilitate a more rapid diagnosis.

Bowel Cancer NZ medical advisor Frank Frizelle said it is important for patients to tell their GP all relevant information and for that to then be passed on in a referral.

A standardised form, which has become the norm in many larger DHBs, would make a huge difference to the time it took for symptomatic patients to be diagnosed, he said.

Ministry of Heath national clinical lead for cancer services Dr Suzanne Beuker said she welcomed the audit as it is particularly useful for guiding discussion between the ministry, it’s expert group, and DHBs about how to make improvements in the provision of care for people with bowel cancer.

“We know that there are many steps in quality improvement, but key ones are measuring outcomes, looking carefully at the results, planning improvements, putting them in place and then beginning the cycle again.”

The research is a useful measurement of the effectiveness of the guidelines to fast-tract treatment and the ministry’s National Bowel Cancer Working Group will be discussing the audit in their next meeting in June, she said.

According to the Ministry of Health, CRC is the second most common cause of cancer death in both males and females in New Zealand.


  1. The development of an innovative Specialist Review Clinic in the Eastern Bay of Plenty; where a specialist for half a day a week reviews community patients of his specialty,and assesses urgency of treatment and treatment prioritisation. This could be extended with both senior registrar’s and fellows across all disciplines and be funded by the DHB’s either for half a day or a day a fortnight, which has been proven in the Whakatane trial to not only improve assessment and treatment prioritisation, but to greatly improve patient communication and satisfaction.Despite being favourably reviewed in a national health forum with significant positive feedback, there has been a lack of interest by hospitals and the DHBs.


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