Abstract
BackgroundAlthough less common cancers account for almost 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, long times to diagnosis, and poor clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem.AimTo examine the less common cancers identified during the MDC pilots and consider whether such an approach improves the diagnosis of these cancers.Design and settingA service evaluation of five MDC pilot projects in England from December 2016 to March 2019.MethodData 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 χ2 tests for proportions and t-tests for means where appropriate.ResultsFrom 5134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. More than 30 different less common tumour types were diagnosed in this cohort. Of the MDC patients with less common cancers, 23% (n = 50) had ≥3 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.ConclusionA 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.
Highlights
Of the Multidisciplinary Diagnostic Centre (MDC) patients with less common cancers, 23% (n = 50) had ≥3 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
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 sitespecific urgent referral
The relative scarcity of less common cancers often makes the risk of cancer in symptomatic patients lower than the UK’s recommended 3% threshold for urgent cancer investigation, even when symptoms are highly specific to the cancer.[5,6,9,14]
Summary
Rare and less common cancers (hereafter ‘less common cancers’) account for almost half of all cancer diagnoses in England and over half of all cancer deaths.[1,2,3] This broad term incorporates >200 different tumour types, excluding the four most common malignancies: breast, colorectal, lung, and prostate cancers (hereafter ‘common cancers’).[4]With the exception of cervical cancer, there is currently no established screening programme for less common cancers,[5] and recognition of disease relies on the development and presentation of symptoms.[6,7,8] In many cases, these cancers present with non-specific symptoms, which can originate from multiple benign conditions.[6,9,10,11] For example, unexpected weight loss is associated with several cancers at all cancer stages but may arise from serious and non-serious diagnoses associated with a wide range of body systems.[12,13] the relative scarcity of less common cancers often makes the risk of cancer in symptomatic patients lower than the UK’s recommended 3% threshold for urgent cancer investigation, even when symptoms are highly specific to the cancer.[5,6,9,14] The range of possible conditions and the low likelihood of cancer complicates the choice and timing of diagnostic investigation in primary care. Rare and less common cancers (hereafter ‘less common cancers’) account for almost half of all cancer diagnoses in England and over half of all cancer deaths.[1,2,3] This broad term incorporates >200 different tumour types, excluding the four most common malignancies: breast, colorectal, lung, and prostate cancers (hereafter ‘common cancers’).[4]. Less common cancers account for almost 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, long times to diagnosis, and poor clinical outcomes.
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