Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation

Abstract

Background: Although less common cancers account for over half of all cancer diagnoses in England, their relative scarcity and complex presentation, often with non-specific symptoms, means that patients often experience multiple primary care consultations, longer times to diagnosis and poorer clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem. Aim: To examine the less common cancers identified during the MDC pilots and consider if such an approach improves the diagnosis of these cancers. Design and Setting: A service evaluation of five MDC pilot projects in England to 31st March 2019. Method: Data items were collected by pilot sites in near-real time, based mainly on the English cancer outcomes and services dataset, with additional project specific items. Simple descriptive and comparative statistics were used, including chi-squared tests for proportions and t-tests for means where appropriate. Results: From 5,134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. Over 30 different less common tumour types were diagnosed within this cohort. 23% of MDC patients with less common cancers had ≥3 more GP consultations before referral and, at programme level, a median time of 57 days was recorded from GP urgent referral to treatment for these tumour types. Conclusion: A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.

The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review

“…Six of the ten included studies were from Denmark [ 12 , 16 , 17 , 24 – 28 ] One was from Sweden, Two from UK and one from the Netherlands [ 10 , 21 , 23 , 29 ]. The six studies from Denmark, the one from Sweden and the two from UK investigated patients with non-specific symptoms of cancer who were referred to a DC for further examination whereas the study from the Netherlands investigated GPs’ gut feelings regarding cancer possibility [ 10 , 12 , 16 , 17 , 20 , 21 , 23 – 28 , 32 ]. The studies from Denmark were conducted in specific regions of the country except for the study by Moseholm et al which was a nationwide study [ 12 , 16 , 17 , 24 – 28 ].…”

“…Denmark, Norway, Sweden and UK are the only countries who have an urgent referral pathway for patients with NSSC, hence it could be more likely that relevant studies have been made in the native languages. Studies from UK are pilot studies, hence urgent referral pathways and the related diagnostic center are not implemented in all of UK at this moment [ 20 , 21 ]. Also authors language is Scandinavian hence these languages are naturally read.…”

Early diagnosis of cancer: systems approach to support clinicians in primary care

“…Delays and uncertainty in care may cause patients unnecessary anxiety about cancer risk and result in further diagnostic delays because of reluctance to seek or re-seek healthcare advice, failure to follow advice, missed appointments, or communication breakdown 101112. Pathways have now been developed to investigate non-specific symptoms such as abdominal pain that may be associated with several cancers as well as benign or other serious diseases, and these may support primary care investigation of patients who would not otherwise be eligible for urgent referral 13…”

The pathway and characteristics of patients with non-specific symptoms of cancer: A systematic review

“…Six of the ten included studies were from Denmark [12,16,17,[24][25][26][27][28] One was from Sweden, Two from UK and one from the Netherlands [10,21,23,29]. The six studies from Denmark, the one from Sweden and the two from UK investigated patients with non-specific symptoms of cancer who were referred to a DC for further examination whereas the study from the Netherlands investigated GPs' gut feelings regarding cancer possibility [10,12,16,17,20,21,[23][24][25][26][27][28]32]. The studies from Denmark were conducted in specific regions of the country except for the study by Moseholm et al which was a nationwide study [12,16,17,[24][25][26][27][28].…”