First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer

Dave Chapman ,Poirier ,Karen Fitzgerald ,William Hamilton ,Greg Rubin ,Daniel Vulkan ,Stephen W Duffy

doi:10.1038/s41416-020-0947-y

Abstract

BackgroundPatients with non-specific symptoms often experience longer times to diagnosis and poorer clinical outcomes than those with site-specific symptoms. This paper reports initial results from five multidisciplinary diagnostic centre (MDC) projects in England, piloting rapid referral for patients with non-specific symptoms.MethodsThe evaluation covered MDC activity from 1st December 2016 to 31st July 2018, with projects using a common dataset. Logistical regression analyses were conducted, with a diagnosis of any cancer as the dependent variable. Exploratory analysis was conducted on presenting symptoms and diagnoses of cancer, and on comparisons within these groupings.ResultsIn total, 2961 patients were referred into the MDCs and 241 cancers were diagnosed. The pathway detected cancers across a broad range of tumour sites, including several rare and less common cancers. An association between patient age and cancer was identified (p < 0.001). GP ‘clinical suspicion’ was identified as a strong predictor of cancer (p = 0.006), with a reduced association with cancer observed in patients with higher numbers of GP consultation before referral (p = 0.008).ConclusionsThe MDC model diagnoses cancer in patients with non-specific symptoms, with a conversion rate of 8%, demonstrating the diagnostic potential of a non-site-specific symptomatic referral pathway.

Highlights

Patients with non-specific symptoms often experience longer times to diagnosis and poorer clinical outcomes than those with site-specific symptoms
The most important aspect of the study is that 8% of referrals resulted in a cancer diagnosis, with 241 cancers diagnosed from a referral cohort of 2961 patients
Most referrals do not result in a cancer diagnosis for the patient, the reported conversion rate of 8% exceeds the positive predictive value of 3% recommended for urgent definitive investigation,[2] and remains consistent with national guidance

Summary

Introduction

Patients with non-specific symptoms often experience longer times to diagnosis and poorer clinical outcomes than those with site-specific symptoms. CONCLUSIONS: The MDC model diagnoses cancer in patients with non-specific symptoms, with a conversion rate of 8%, demonstrating the diagnostic potential of a non-site-specific symptomatic referral pathway. Patients with non-specific symptoms more frequently have multiple GP consultations before referral,[6,7,8] potentially contributing to longer intervals from presentation to diagnosis of cancer.[6,7] Patients in this cohort are associated with higher rates of cancer diagnosis via emergency presentation[6,9] and of late-stage cancer diagnoses,[6] both of which contribute to poorer clinical outcomes[10,11,12] and poorer patient experience of care.[13]

Methods

Results

Discussion

Conclusion