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Introduction Stage at diagnosis strongly influences outcomes in gastrointestinal cancers, but the association between non-urgent referrals and late-stage (III-IV) presentation remains poorly studied. This study examined temporal and geographic trends in National Health Service (NHS) gastroenterology referral-to-treatment (RTT) waiting times, late-stage diagnosis of bowel or oesophageal cancer and their association.Methods Population-level data for England (2014–2022) were analysed using national cancer registration datasets, NHS RTT data, and population estimates. Crude and age-standardised incidence rates were calculated using indirect standardisation nationally and by Integrated Care Board (ICB). Median RTT waiting times were correlated with late-stage diagnoses using Spearman’s rank, stratified by year and adjusted for age.Results Bowel cancer incidenceNational crude incidence rates for bowel cancer remained stable between 2014 (54.8 per 100,000 [95% CI 54.2–55.5]) and 2022 (55.8 per 100,000 [95% CI 55.2–56.4]), except following COVID-19 (2021: 33.5 per 100,000 [95% CI 33.0–34.1]). The proportion presenting at late-stage also remained similar (2014: 55.6% [95% CI 54.8–56.4], 2022: 53.0% [95% CI 52.2–53.8]).Oesophageal cancer incidenceOesophageal national crude cancer incidence rates were also stable but lower, at 11.0 per 100,000 [95% CI 10.7–11.3] in 2014 and 11.7 per 100,000 [95% CI 11.4–11.9] in 2022, but the proportion presenting at late-stage was consistently higher: 72.6% [95% CI 71.4–73.8%] in 2014 to 80.7% [95% CI 79.6–81.8%] in 2022.Gastroenterology RTTVariation across ICBs increased over time, with the interquartile range for gastroenterology RTT widening from 1 to 2 weeks (figure 1).CorrelationOverall, RTT only showed a positive correlation with late-stage oesophageal cancer (ρ=0.10, p=0.04). Following COVID-19, however, RTT became positively correlated with late-stage bowel cancer (2021: ρ=0.33, p=0.03; 2022: ρ=0.31, p=0.05) (adjusted for age by indirect standardisation to England, 2019).Conclusions Between 2014 and 2022, the increase in delays in RTT gastroenterology pathways were associated with late-stage oesophageal cancer diagnoses, with increasing geographic disparities in waiting times, and with late-stage bowel cancer diagnoses post-COVID-19. Prioritising diagnostic capacity and access across ICBs, and for RTT pathways outside urgent cancer referrals, will be essential to reduce late-stage cancer diagnoses and improve patient outcomes.Abstract P274 Figure 1Box plot of the distribution of gastroenterology RTT waiting times (weeks) across integrated care boards in the NHS, England, 2014-2022.