Background Few studies have examined the effect on survival in lung cancer of fast-track referral, while those that do have questioned the utility of the two-week fast track referral rule 1. Paradoxically, delayed referral was associated with longer survival 2. No studies which examined this factor in mesothelioma survival have been published. We therefore examined the effect of mode of referral on survival in malignant mesothelioma.
Methods All 88 patients with malignant mesothelioma in York and North Yorkshire between 2002 2011, where referral data was known, were examined for age at presentation, performance status (PS) and survival using Cancer Registry data with SPSS v19.
Results Three categories of referral were identified: 33 Fast Track (FT), 20 non Fast Track (NFT) and 35 Acute Admission (AA).
There was no difference in median [interquartile range] for age between FT (71.7 [68.3 74.6] years), NFT (69.4 [65.0 73.8 years) and AA (74.1 [70.7 77.5] years).
AA patients had a worse PS (2 [1.4 2.2]) than FT (1 [0.7 1.3]) and NFT (1 [0.5 1.5]), p = 0.03, analysis of variance (ANOVA). No difference was seen between FT and NFT.
Survival was significantly shorter in AA (3 [2.4 8.1] months) than for FT (6 [6.6 14.2] months) and NFT (10 [8.4 16.4] months), p = 0.01, ANOVA.
Results in the three groups are confirmed graphically using Kaplan-Meier survival analysis ( Fig.1 )
Conclusions We have shown that patients admitted acutely with malignant mesothelioma have a worse performance status and shorter survival than patients referred to clinic either via the FT two week rule or NFT. No survival benefit was seen for FT, perhaps because they were more advanced at presentation, as has been shown for patients with lung cancer.