{
  "abstract": "Introduction NICE guidance recommends referral via the 2WW UGI cancer pathway for patients aged ≥55 years presenting with weight loss and alarm symptoms. NHSE data suggests that up to 33% of upper GI cancer are diagnosed via emergency presentations, despite continued rise in 2WW referrals with referrals to the target pathway in 2022 reaching 120% of pre-pandemic levels. The Faster Diagnostic Standard, introduced in 2021, puts pressure on diagnostic services to ensure diagnoses are made within 28 days of referral, this has implications for patients on other pathways who wait longer for investigations. This retrospective study looked at upper GI cancer diagnoses in under 55s, and the impact of a new post-A&E nurse led target clinic.Methods This was a single centre retrospective study reviewing all new cancer diagnoses made on the upper GI 2WW pathway and all cancer diagnoses in under 55s. All UGI/HPB cancers diagnosed between 2022 to 2025 were reviewed, including demographics, route to diagnosis and cancer type.Results A total of n=663 cancers were diagnosed between 2022-2025. Of those, 65 (9.8%) of cancers were diagnosed in patients under 55 years, 11 were 40 years or under (2.4%). In the 65 cancers diagnosed in patients under 55, only 26 (40%) were referred via the 2WW pathway. 19 came from routine referral pathways (29.3%) and the remaining 20 had presented via A&E (30.7%). In terms of types of cancer diagnosed in under 55s, 31 were from the upper GI tract (oesophagogastric or duodenum), 4 cholangiocarcinomas, 4 neuroendocrine tumours, 5 lymphoma (of GI origin) 16 pancreatic cancers and 5 GISTs.Since establishing a nurse led post-A&E target pathway, 204 referrals were reviewed & investigated in 18 months, the pick up rate for malignancy was 11%. The mean age of patients referred via this new pathway was 62 years (range 21-98), 69 patients (33.7% of referrals) were < 55 years age.Conclusion While the majority of upper GI cancer are diagnosed in older people, in our study 9.8% of diagnoses were under 55 years. The 2WW pathway age cut off of 55 could be a deterrent for primary care referral of younger patients with symptoms, with these patients often being diagnosed through A&E or routine pathways. We have developed a local post A&E pathway to ensure that patients get appropriate investigations in a timely fashion akin to target referrals from GPs.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Barnet & Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "William Waddingham"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Barnet & Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Chehkuan Tai"
    }
  ],
  "title": "P286 Diagnosis of upper-GI cancers in under 55s via the two week wait pathway: impact of a post-A&E nurse target clinic",
  "uid": "1e01122f-de44-5c13-b376-992b57e8010f"
}