The effectiveness of the Guy’s Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients

Abstract

Background Rapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy’s RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population. Methods We evaluated all patients referred to Guy’s RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service. Results There were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)—with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15–47) and treatment 56 days (IQR 32–84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%). Conclusions RDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%—justifying the RDC approach in vague symptom patients.

Characterisation and outcomes of patients referred to a regional cancer of unknown primary team: a 10-year analysis

“…Such ambitions have been the focus of several initiatives including the Accelerate, Coordinate, Evaluate programme in the UK aimed at improving the early diagnosis of cancer [15][16][17]. The emergence of rapid access diagnosis clinics (RADC) or multidisciplinary diagnostic centres (MDC) in some areas, including those specifically for patients with non-specific but concerning or 'vague' symptoms, may provide a model for patients who do not fit cancer-specific 'suspicion of cancer' referral criteria [16,18,19]. Notably, the cancer diagnosis rate frequently reported by RADC, MDC and 2-week-wait referral pathways, including patients referred with 'vague symptoms', is about 8% [16].…”

Intra-abdominal cancer risk with abdominal pain: a prospective cohort primary care study

“…3 As part of this strategy, Rapid Diagnostic Centres (RDCs) are being established to assess patients whose potentially serious, but non-specific, symptoms do not warrant an urgent, site-specific referral. 4,5,6 Piloted in Denmark, these multidisciplinary units conduct diagnostic imaging, blood, and urine investigations, with cancer detection rates of 7-12%. [5][6][7][8] Cancer patients attending RDCs were likely to have multiple signs, symptoms or abnormal tests indicating possible cancer (termed "features").…”

Urgent cancer referrals: how well are they working and can they be improved?

“…This may now be improved by rapid diagnostic centres allowing GPs to refer patients with vague symptoms and those where there is sufficient worry about a cancer diagnosis. 6 While the numbers were large in the Round et al study, it did not allow detailed analysis of differences between the site-specific pathways. This is a knowledge gap that needs addressing, as there is known to be variation on the performance metrics between the different cancer pathways.…”