Referral Cancer Research Articles

The Impact of the COVID-19 Lockdown on Cancer Referrals in Primary Care in the UK: Two Years On

Background: Cancer is common, with most cancer patients presenting initially to a general practitioner. The COVID-19 pandemic led to changes in the delivery of primary care, which could have affected cancer referrals. This observational study looked at two-week cancer referrals (2WRs) made before, during and after the first UK COVID-19 lockdown in 2020, at a GP practice in the Wirral, England. Methods: A search was conducted to find the cancer referrals made between 23rd March 2020 - 1st July 2020, during the first lockdown. Using the same methodology, cancer referral data was collected for the corresponding time periods in 2019 and 2021. The number of 2WRs and positive diagnostic yields were then compared. Results: The number of cancer referrals decreased by 40.4% in 2020, compared to 2019. In 2021, the number of referrals then increased by 225%, compared to 2020. Overall, the number of cancer referrals increased between 2019-2021. The positive diagnostic yield for the 2020 2WRs increased by 251.4%, compared to that of 2019. The calculated yield for the 2021 data then decreased by 10.8% compared to 2020. Overall, the positive diagnostic yield increased between 2019-2021. Conclusion: The numbers and outcomes of cancer referrals at this Wirral GP practice have changed considerably following the first UK COVID-19 lockdown in 2020, and the influence of the pandemic was still affecting cancer referrals in 2021. A greater focus on early cancer detection in primary care could help overcome the ways in which the pandemic has affected primary care delivery.

Bridging Innovation and Education: IJMS Volume 12 Issue 3 and the 2024 World Conference on Medical Student Research (WCMSR)

The International Journal of Medical Students (IJMS) is proud to present Volume 12, Issue 3, highlighting innovative research across various medical disciplines. This issue underscores the journal's commitment to fostering medical education and advancing healthcare. Featured articles explore critical areas, including narrative medicine's role in reducing burnout, stress management among medical students, and the long-term impacts of the COVID-19 pandemic on cancer referrals and treatment decisions. Public health concerns such as antimicrobial resistance and access to syphilis screening in vulnerable populations are also examined. Additionally, this edition includes insightful reviews on pediatric allergy consultations and the utility of ultrasound in anatomical dissection courses. Case reports on rare medical conditions, reflections on global surgical electives, and personal experiences in overcoming research challenges further enrich the content. To complement this issue, the IJMS announces the 2024 World Conference on Medical Student Research (WCMSR), taking place on October 26, 2024, with participants from over 40 countries. This event promises to be a valuable platform for showcasing the best global research, fostering discussion, and inspiring the next generation of medical professionals.

Impact of a care delivery intervention for patients with socioeconomic disadvantages, in their preferred language of English or Spanish.

97 Background: Sinai Health System’s oncology program serves Chicago’s inner city patients with substantial needs for social and primary care, many of whom prefer communication in Spanish. Sinai has implemented a care delivery intervention to address these needs, using the 4R Oncology Model for patient-facing care planning and patient self-management. 4R (Right Info/Care/Patient/Time) has shown significant improvements in the timeliness of care cancer delivery and referrals to cancer care (1). Herein, we implemented the 4R intervention to improve the timeliness of care delivery and referrals to care, focusing on the social and primary care needs of Sinai patients. Methods: Evaluation was conducted by surveying historical control and intervention (4R) cohorts of patients in their preferred language of Spanish or English. The 4R cohort received care at a Sinai medical oncology clinic Apr 2023 - Jan 2024. Control cohort received care Jan 2023 – March 2023. Analyses were conducted using Fisher’s exact test. Results: Survey response rates: 76% (38/50) in control and 75% (33/44) in 4R cohorts. Participant characteristics were comparable between control and 4R cohorts, respectively: 55%, 58% Hispanic, 42%, 39% Black; 76%, 82% high school education or less; 87%, 97% < 30k income; 50%, 55% preferred language Spanish; 47%, 45% English. For the total cohorts, all 5 metrics improved between control and 4R, and 4 of the 5 metrics improved significantly (Table). Among Spanish-preferred patients, 3 of the 5 metrics improved significantly, while improvements among English-preferred patients were not statistically significant. Both language groups saw numerical, but not statistically significant improvement in receiving referrals to primary care and meeting all their practical and family needs. Conclusions: The 4R Oncology intervention resulted in significant improvement in time to treatment and referrals to social and primary care in our population of socioeconomically disadvantaged patients with high needs for these services. Patients preferring Spanish benefited at a higher rate than English-preferring patients, indicating that 4R may be an effective method to address the needs of this important patient group. Future efforts will further optimize 4R to address remaining gaps for this group, as well as to improve the delivery of this care for the English-preferred patients. 1. Trosman JCO OP 2021. Metric Control Total %N=38 4R Total %N=33 Control Spanish %n=19 4R Spanish %n=18 Control English %n=19 4R English %n=15 Started treatment within 6 weeks of diagnosis 61 88* 53 94* 68 80 Received referral to primary care 66 82* 74 83 58 80 Received referral to support for transportation, food, and other needs 68 85* 63 89* 74 80 Referred to help and resources to help pay for care 50 67* 47 78* 53 53 All of my practical and family needs were addressed 86 89 84 89 87 87 *p<0.1 comparing control and 4R cohorts.

Socioeconomic Inequality in the Head and Neck Cancer Referral System: Redressing the Balance.

Socioeconomic deprivation is a known risk factor for head and neck cancer (HNC). Despite this, there is no current way to acknowledge this in two-week wait (2WW) referrals. 2WW HNC referrals have continually risen, and a self-reporting questionnaire was trialled with referrals to the ear, nose and throat (ENT) department with suspected HNC, allowing additional triage information not included in referrals to be obtained. Patients referred through the 2WW pathway for HNC between February 2021 and March 2022 were asked to complete an electronic self-reporting symptom questionnaire. The vetting process resulted in the referral being accepted or regraded to less urgent referral streams. Scottish Index of Multiple Deprivation (SIMD) quintiles were derived using the online postcode checker tool. A total of 984 2WW referrals were retrospectively reviewed. The questionnaire was completed by 717 (72.9%) patients. Regrading of urgency resulted in 292 (29.7%) 2WW appointments not required. Of those regraded, 264 (90.4%) patients completed the questionnaire. A significantly greater number of patients (p = 0.03) from SIMD 4 and SIMD 5 were regraded (33.3%) compared to SIMD 1 and SIMD 2 (26.4%). Patients who did not complete the questionnaire had a higher median age (61.0 years, range: 17-96, IQR: 25.0) compared to those who completed the questionnaire (56.0 years, range: 17-88, IQR: 23.5, p < 0.001). A self-reported symptom questionnaire can help rebalance urgent appointments to those with genuine red flag symptoms. This in turn reduces social inequality in 2WW referrals and reduces the number of inappropriate 2WW appointments.

Technology for fast-tracking high-risk head and neck cancer referrals: Co-designing with patients

BackgroundHead and Neck Cancer (HNC) is the eighth most prevalent global cancer. Timely recognition of symptoms is crucial for reducing mortality rates. The EVolution of a patiEnt-REported symptom-based risk stratification sySTem to redesign the suspected Head and Neck cancer referral pathway (EVEREST-HN) study aims to develop and evaluate a risk stratification tool using patient reported symptoms, which will be populated remotely in the community before the patient is seen by the clinician to hasten HNC diagnosis. EVEREST-HN will design a patient SYmptom iNput Clinical (SYNC) system to gather patient symptom data and calculate a risk score to aid clinicians in identifying high-risk cases. This identification potentially allows for high-risk patients to be seen sooner, thereby improving patient outcomes. MethodsThree workshop sessions were conducted involving a total of 17 unique participants, with several contributing to multiple sessions: nine in the co-design session, six in the validation session, and nine in the evaluation session. The co-design session employed online collaboration with patients’ representatives. Thematic analysis was used to identify requirements and concerns informing the development of a low-fidelity prototype. The validation session assessed whether the prototype aligned with patient expectations. In the evaluation session, participants interacted with an online prototype and provided further feedback. ResultsDuring the co-design workshop, participants emphasized the need for a concise and clear SYNC system questionnaire for reporting suspected HNC symptoms. Concerns were raised about questionnaire length, language clarity, and the inclusion of probing questions. Participants suggested concise questions using lay language, incorporating visual aids for topics like alcohol and tobacco use, and making the sexual activity question optional. Recommendations included diverse language options, hard copies for non-English speakers, and phone call options for those uncomfortable with screen-based technology. The validation workshop confirmed that the prototype reflected participants’ ideas. Feedback highlighted the need for call-back features to help those not confident with technology and the need to present symptom questions first before social background questions. Feedback from the evaluation demonstrated a commitment to efficiency, and continuous improvement. ConclusionThis study aims to develop the SYNC system to enhance efficiency of suspected HNC referrals. The workshops highlighted the importance of end-user inclusiveness in the system development life cycle, with collaboration with stakeholders and repeated feedback, providing crucial insights for ensuring the SYNC system effectively addresses the needs and concerns of patients in the context of HNC diagnosis.

Abstract C132: Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles

Abstract Introduction: Multilevel barriers to screening and follow-up contribute to persistent disparities in cervical cancer burden, particularly in marginalized communities receiving care in safety-net healthcare settings. While evidence-based interventions (EBIs) exist for improving cancer screening and follow-up, building capacity to identify effective strategies for implementation and alignment of EBIs to the context of safety-net settings and the diverse communities they serve is critical. Methods: Supported by the HRSA Accelerating Cancer Screening Program, Chinatown Service Center, a multi-site Federally Qualified Health Center (FQHC) serving Chinese and Latino/a populations in Los Angeles, and USC Norris Comprehensive Cancer Center established a new partnership to identify multilevel factors that impact cervical cancer screening, follow-up and referral and inform the implementation of EBIs to improve care. We conducted a mixed methods assessment June-December 2023 to understand care processes through surveys and qualitative interviews (20-30 minutes, guided by the Consolidated Framework for Implementation Research) with providers and clinic staff and medical chart reviews of patients with ≥ 1 cervical cancer screening order January 2020-March 2023. Results: Surveys (n=23) showed higher knowledge of screening guidelines (p&amp;lt;0.05) and more confidence discussing cervical cancer with patients (p&amp;lt;0.05) among providers compared to clinic staff, indicating opportunities for staff training. Qualitative interviews (n=23) identified inner setting barriers such as limited system-level implementation of cervical cancer screening guidelines and limited technology supports to track patients requiring follow-up. At the individual level, older patients and those not sexually active often declined testing and requested gender concordant (female) providers. Motivation for building cervical cancer care capacity within the FQHC were noted, with clinic members highlighting FQHC strengths in addressing cultural barriers, social needs, and community outreach. Several outer setting barriers emerged for referral and follow-up care, including long wait times for referrals, trouble finding language concordant specialists, transportation barriers, and difficulty accessing specialists through their managed care network. Medical chart abstractions (n=1,428) identified opportunities to improve closed-loop communication with specialists and limited ease for clinic staff identify high and low risk screening results for further treatment. Discussion: By establishing a new FQHC-NCI cancer center partnership, we advanced our combined capacity to address cervical cancer care equity in marginalized communities. We identified patient-level (cultural, logistic, social determinants), provider/clinic staff-level (training needs, patient tracking), and system-level (access to and communication with specialists) barriers that will require selection of EBIs and implementation strategies via a partnered approach with local specialists, health systems, payers, and policymakers. Citation Format: Jennifer Tsui, Samantha Garcia, Emily Dang, Alejandra Ramos, Allison Oh, Kathy Lui, Angela Ching, Eugene Hui, Chanita Hughes Halbert, Lourdes Baezconde-Garbanati, Jack Cheng. Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C132.

Abstract A139: Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study

Abstract Purpose: While lung cancer is a leading cause of death in the U.S., annual lung cancer screening (LCS) rates remain low. After deployment of an implementation intervention to increase lung cancer screening (LCS) and referral, we used a qualitative approach to identify barriers and facilitators, and recommended supports to increase screening. Methods: Semi-structured interviews were conducted with patients (n=66) and providers (n=59) across 15 BJC Consortium hospitals. Interview domains included perceptions and experiences with LCS referral and completion, barriers and facilitators to LCS, and the impact of the COVID-19 pandemic on these processes. Patients were eligible if they had been referred for LCS. Providers were eligible if they were involved in the LCS decision-making and referral process. Interviews were audio-recorded, de-identified, and transcribed. Deductive and inductive codes were developed separately for patients and providers. Coded data were analyzed to determine themes. Results: Patients cited transportation, uncertainty surrounding insurance coverage for screening, and the COVID-19 pandemic as barriers to accessing LCS. Due to the Medicare and Medicaid requirement of a documented shared decision-making visit prior to providing an LCS referral, providers cited time constraints during patient encounters as a barrier to delivering optimal LCS care. Both patients and providers reported low general awareness of LCS (compared to other preventive screening services) as a barrier to utilization. Patients described many facilitators to LCS including fears regarding cancer risk, knowledge of the benefits of early cancer detection in improving cancer outcomes, provider recommendations, ease of LCS process, and receiving educational materials about LCS. Providers also describe access to evidence-based outreach and education materials regarding LCS, and implementation of clinical decision support tools (e.g. pre-screening for LCS eligibility and insurance authorization, integration of EMR prompts centered around LCS and nodule surveillance) as facilitators for screening. Patients and providers highlighted the importance of LCS navigators in facilitating communication and reducing barriers to LCS and surveillance – specifically, patients found one-on-one support and education with navigators to be encouraging as they underwent LCS. Conclusion: While there are some key barriers related to lung cancer screening and follow-up, there are many facilitators to screening that can be leveraged to increase referrals and enable successful follow-up management after screening. Recommended additions to basic lung screening intervention materials include provider education on how lung cancer screening referral processes are unique in comparison to other screenings, how providers can foster patient understanding of lung nodules, and local support and resources to help patients navigate barriers to lung screening. Citation Format: Amy Ayala, Meera Muthukrishnan, Sydney Beache, Michelle Silver, Courtney Harriss, Graham Colditz, Aimee James. Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A139.

FP1.12 - How many Colorectal cancer patients had negative Faecal Immunochemical Testing (FIT) within the previous 1 year?

Abstract Introduction Colorectal cancer (CRC) accounts for approximately 10% of all cancer diagnoses and 9.4% of all cancer deaths worldwide. Since its introduction, quantitative faecal immunochemical testing (qFIT) has become a vital tool in bowel cancer screening and triaging of symptomatic patients. Our trust has seen a 20% increase in lower gastrointestinal referrals over a 12-month period. The aim of this investigation was to identify how many patients with a negative qFIT were diagnosed with CRC within 12 months and if there is potential to downgrade referrals with negative qFIT. Methods This retrospective study reviewed new CRC diagnoses in one hospital trust, diagnosed from January to December 2022, who were referred as symptomatic red flag referrals. All patients in this timeframe had records reviewed for qFIT performed within the 12 months prior to their diagnosis. A negative qFIT test was defined as lab result of &amp;lt;7ugHb/g. Results Two hundred and forty-seven patients were diagnosed with CRC from January to December 2022. One hundred and three patients did not have a documented qFIT within the timeframe and therefore were excluded from analysis. One hundred and forty-four cases were further reviewed, of which 14 (9.7%) had a negative qFIT within the 12 months before diagnosis. Conclusions This audit does not support the downgrading of Red Flag referrals based on a negative qFIT result. Further analysis is needed to ascertain how best to triage symptomatic referrals for colorectal cancer with a negative qFIT to help cope with an increasing burden of Red Flag referrals.

FP4.14 - The Efficacy of Performing A Quantitative Faecal Immunochemical Test (qFIT) As A Predictor of Colorectal Cancer Before A 2-Week Wait Referral

Abstract Aim 2-week wait (2ww) Colorectal cancer (CRC) referrals have risen along with increased use of colonoscopy, potentially exposing patients to repeated invasive investigation. Current guidelines recommend the use of quantitative faecal immunochemical testing (qFIT) in primary care to prioritise patients for investigation. This study aims to characterise 2ww CRC referrals in a London hospital. Method This is a retrospective quality improvement study, analysing primary care 2ww CRC referrals in October 2022 in a London hospital. Data collected included referral symptoms, completion of a qFIT prior to referral, previous exclusion of CRC, and subsequent investigation outcome. Results Of 173 patients referred on the CRC 2ww pathway in October 2022, 21% did not require further investigation. 16% of patients had undergone a colonoscopy within 12 months excluding CRC. Only 61% of referrals included a qFIT. 71% of these were qFIT positive, and 11% were diagnosed with CRC. The overall CRC detection rate was 2.2%, all with qFIT &amp;gt;200. The PPV of qFIT for CRC was 5%, and 53% for polyps. Conclusion 39% of this patient cohort were referred without qFIT. Those who are qFIT negative or have had CRC excluded in the past 12 months may not require investigation on a 2WW pathway, may be suitable for investigation with lower priority, and may not need invasive investigation at all. Although the use of qFIT has been nationally recommended to prioritise the urgency of investigation, this study suggests this has not been universally adopted. Wider use of qFIT before 2ww referral may guide the use of resources and aid diagnosis and management of patients with symptoms of CRC.

ThP3.1 - Dysphagia: Should we be going straight to scope? A retrospective analysis within a single Scottish District General Hospital

Abstract Aim Dysphagia is the main symptom in patients with oesophageal cancer. British Society of Gastroenterology guidelines state that all patients with an Edinburgh Dysphagia score (EDS) of &amp;gt;3.5 should be investigated with an urgent oesophagogastroduodenoscopy (OGD) for suspicion of cancer. We aim to investigate the outpatient clinic outcome for patients referred with dysphagia. Methods A retrospective cohort study of all urgent suspicion of cancer (USOC) referrals with dysphagia between April to September 2022. Patients demographics, clinic outcome and waiting time for OGD were analysed. This study was registered with Clinical Quality Project (LanQIP 14747). Results 138 (37.5%) of 361 USOC referrals had dysphagia. Median age was 63 years (IQR 51-72) and 78 (56.5%) were female. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-6). 3 (2.2%) patients were referred straight to scope. 125 (90.6%) patients attended clinic, of these 106 (84.8%) patients had an OGD requested. 84 (67.2%) were requested urgently, 16 (12.8%) routinely and 25 (20%) did not receive a scope. The median waiting time to clinic was 42 days (IQR 62-31) and median time from clinic to OGD was 36 days (IQR 24-59). Total waiting time from the referral to OGD was 81 days (IQR 62-111). Conclusions The majority of patients presenting with dysphagia will necessitate urgent OGD following clinic consultations. Therefore, to expedite the diagnostic process, implementing a direct referral pathway to endoscopy, bypassing clinic wait times, is recommended.

SP9.1 - Enhancing Personalised Care by Introducing Frailty Management On Lower GI 2ww Pathway

Abstract Introduction/Aim Increasing number of patients with suspected lower GI cancer are being sent Straight-To-Test to achieve the 28Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have piloted a frailty pathway incorporated into the protocol for management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes. Methods A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-November2023 was analysed. Patients age&amp;gt;75 with a frailty score&amp;gt;=5 or performance status&amp;gt;=3, dementia, poly-pharmacy or from care home were referred straight to the frailty-unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard pathway. Results Over 22 months-period, 228 patients with suspected cancer were seen on the frailty pathway. The average number of investigations per referral was0.5 for frail patients compared to 1 for other patients on the standard pathway. 49.5% (113 patients) were found to be unfit for further investigations or declined/self-discharged. 5 patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. The 2ww standard was met in 80% of frail patients compared to 55% in &amp;gt;75s who were sent straight-to-test on the standard pathway. The 28-day FDS standard was met in 50% of frail patients compared with 18% in &amp;gt;75s. Conclusion The frailty pathway is an effective initiative in reducing unnecessary invasive investigations. Frail patients benefit from holistic geriatric assessment prior to invasive investigations, ensuring suitability and appropriateness.

SP9.3 - Introducing Frailty Assessment into The Suspected Lower GI Cancer Pathway – Results of a 2 Year Pilot

Abstract Introduction &amp; Aim An Increasing number of patients with suspected lowerGI cancer are being sent Straight-To-Test to achieve the 28 Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have been piloting a frailty pathway incorporated into the protocol for secondary care management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes. Methods A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-January2024 was analysed. Patients aged&amp;gt;75 with a frailty score of &amp;gt;=5 or performance status&amp;gt;=3, dementia, poly-pharmacy or from care home were referred straight to the frailty unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard-pathway. Results Over a 24-month period, 228patients with suspected cancer were seen on the frailty pathway. 49.5%(113patients) were found to be unfit for further investigations or declined/self-discharged. The 2ww standard was met in80%of frail patients compared to55% in&amp;gt;75s who were sent straight-to-test on the standard pathway. The 28day-FDS standard was met in50%of frail patients compared with18%in the other&amp;gt;75s.The average number of investigations per referral was0.5for frail patients compared to 1 for patients on the standard-pathway. 5patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. Conclusion The frailty pathway is an effective initiative in reducing unnecessary invasive investigations, whilst providing timely investigations on the suspected cancer pathway.

Early economic evaluation of magnetic resonance imaging for prostate cancer detection in primary care.

To explore the potential impacts of incorporating prebiopsy magnetic resonance imaging into primary care as a triage test within the prostate cancer diagnostic pathway. Decision analytic modelling with decision trees was utilised for this early economic evaluation. A conceptual model was developed reflecting the common primary care routes to diagnosis for prostate cancer: opportunistic, asymptomatic prostate-specific antigen (PSA) screening or symptomatic presentation. The use of multiparametric MRI (mpMRI) or biparametric MRI (bpMRI) as a primary care triage test following an elevated PSA result was evaluated. A health system perspective was adopted with a time horizon of 12 months. Health effects were expressed in terms of utilities drawn from the literature. The primary outcome was prostate cancer diagnosis. Evidence used to inform the model was drawn from published primary studies, systematic reviews, and secondary analyses of primary and secondary care datasets. Base case analysis showed that the PSA pathway was dominated by both mpMRI- and bpMRI-based pathways for patients undergoing opportunistic screening and symptomatic assessment. bpMRI pathways had greater improvement in cost and utility than mpMRI pathways in both clinical scenarios. Significantly more MRI scans would be performed using the modelled approach (66 626 scans vs. 37 456 scans per 100 000 patients per annum), with fewer subsequent urgent suspected cancer referrals for both mpMRI (38% reduction for screening and symptomatic patients) and bpMRI (72% reduction for screening; 71% for symptomatic) pathways, and a small increase in number of missed cancer diagnoses. Deterministic sensitivity analyses, varying each parameter to its upper and lower 95% confidence intervals, showed no significant change in the dominance of the MRI-based prostate cancer diagnostic pathways. Using prostate MRI as a second-level triage test for suspected prostate cancer in primary care could reduce health service costs without a detrimental effect on patient utility.

Hope and trust in diagnostic imaging contexts – Constituting technology and liminal patients

IntroductionThis study investigates patients’ experience of selected imaging examinations and how human experiences are transformed through technological mediation. MethodA qualitative study of patients' experiences during selected imaging examinations, centering on human-technology relations, was conducted.Data was gathered in two Danish hospitals, through semi-structured interviews and participant observations. The study included fifteen diagnostic imaging examination cases, distributed over three Computed Tomography (CT)-guided lung biopsy interventions, seven conventional CT examinations, and five Positron Emission Tomography CT examinations. The participating patients were undergoing investigation for cancer within Fast Track Cancer Referral Programs (FTCRP).The study has a philosophical approach to practice grounded in Postphenomenology and draws on anthropological studies of healthcare practice as its theoretical and analytical framework. ResultsDiagnostic imaging technologies were found to have existential implications creating hope and trust in patients. Patients demonstrated technological readiness, in their willingness to comply with examination criteria and the professional's instructions. The patient's primary concern was achieving a good examination result, for which they were prepared to push themselves beyond their usual limits.Participating in diagnostic imaging examinations may be viewed as a life crisis ritual, wherein patients are constituted as liminal beings, existing between healthy and sick. ConclusionsThe existential implications of an imaging examination were clear in terms of hope and trust. Hope is related to life and death in two temporal perspectives: A future hope of surviving cancer and a present hope of being cancer-free. Hope was linked to avoiding despair and rested on trusting oneself to technology, thus, forming a circle of interrelated concepts. Implications for practiceProfessionals need to recognize the patients’ liminal passings yet, unnoticed transformative and existential implications, to perform better patient-centered care.

Predictive value of abnormal blood tests for detecting cancer in primary care patients with nonspecific abdominal symptoms: A population-based cohort study of 477,870 patients in England.

Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms. Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged ≥30 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations. A total of 9,427/425,549 (2.2%) patients with abdominal pain and 1,148/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged ≥60, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient's cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use. In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged ≥60 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.

BT08 Outcomes of urgent suspected cancer, urgent and routine skin lesion referrals assessed via teledermoscopy service

BT08 Outcomes of urgent suspected cancer, urgent and routine skin lesion referrals assessed via teledermoscopy service

BT32 Teledermatology service evaluation compared with standard face-to-face review for 2-week-wait skin cancer referrals

BT32 Teledermatology service evaluation compared with standard face-to-face review for 2-week-wait skin cancer referrals

P024 Skin cancer referrals by nonmedical practitioners: a prospective observational study

P024 Skin cancer referrals by nonmedical practitioners: a prospective observational study

BT03 A picture paints a thousand words: simple solutions for optimizing the flow of urgent skin cancer referrals

BT03 A picture paints a thousand words: simple solutions for optimizing the flow of urgent skin cancer referrals

Advice after urgent suspected cancer referral when cancer is not found in England: Survey of patients’ preferences and perceived acceptability

ObjectiveNo standardised approach exists to provide advice after urgent suspected cancer (USC) referral when cancer is not found. This study aimed to assess preferences and acceptability of receiving advice after USC referral related to: 1) managing ongoing symptoms, 2) responding to early symptoms of other cancers, 3) cancer screening, 4) reducing risks of future cancer. Methods2,541 patients from two English NHS Trusts were mailed a survey 1–3 months after having no cancer found following urgent suspected gastrointestinal or head and neck cancer referral. Participants were asked about: willingness to receive advice; prospective acceptability; preferences related to mode, timing and who should provide advice; and previous advice receipt. Results406 patients responded (16.0%) with 397 in the final analyses. Few participants had previously received advice, yet most were willing to. Willingness varied by type of advice: fewer were willing to receive advice about early symptoms of other cancers (88.9%) than advice related to ongoing symptoms (94.3%). Acceptability was relatively high for all advice types. Reducing the risk of future cancer advice was more acceptable. Acceptability was lower in those from ethnic minority groups, and with lower levels of education. Most participants preferred to receive advice from a doctor; with results or soon after; either face to face or via the telephone. ConclusionsThere is a potential unmet need for advice after USC referral when no cancer is found. Equitable intervention design should focus on increasing acceptability for people from ethnic minority groups and those with lower levels of education.