Urgent Suspected Cancer Research Articles

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.

Communicating effectively to patients about a cancer referral.

The UK's National Institute for Health and Care Excellence (NICE) advises GPs to inform patients referred to the Urgent Suspected Cancer (USC) pathway about their impending service and expectations. However, little is known about patient experiences and information needs post-referral. GPs often grapple with conveying the urgency of referrals while offering reassurance. This study explores GP communication regarding cancer and USC referrals. A secondary analysis of 23 audio-recorded GP-patient consultations, selected from a larger dataset of 200 consultations in Surrey and London (2017-2018), was conducted, focusing on discussions related to cancer. We found that most GPs informed patients that they might have cancer and engaged in reassurance about the patient's low risk of cancer using personalised risk statements. Some GPs, however, avoided all mention of cancer, using symptom-led language instead. GPs tended to focus on communicating practical rather than support-based information when discussing the referral. While most GPs informed patients that they would be seen by a specialist within two weeks, few discussed patients' support needs during the referral or specialist appointment. This presentation will offer language recommendations for clear communication about cancer referrals. This plays an important role in promoting shared decision-making and driving patient attendance for investigations. The study highlights the need for further research on communication practices around cancer referral to improve patient understanding and experience. Our recommendations for enhanced communication may improve patient outcomes by optimising routes to diagnosis via primary care.

Understanding GPs' referral decisions for younger patients with symptoms of cancer: a qualitative interview study.

Cancer incidence increases with age, so some clinical guidelines include patient age as one of the criteria used to decide whether a patient should be referred through the urgent suspected cancer (USC) pathway. Little is known about how strictly GPs adhere to these age criteria and what factors might influence their referral decisions for younger patients. To understand GPs' clinical decision making for younger patients with concerning symptoms who do not meet the age criteria for USC referral. Qualitative study using in-depth, semi-structured interviews with GPs working in surgeries across England. Participants (n = 23) were asked to recall consultations with younger patients with cancer symptoms, describe factors influencing their clinical decisions, and discuss their overall attitude to age thresholds in cancer referral guidelines. A thematic analysis guided by the Framework approach was used to identify recurring themes. GPs' decision making regarding younger patients was influenced by several factors, including personal experiences, patients' views and behaviour, level of clinical concern, and ability to bypass system constraints. GPs weighted potential benefits and harms of a referral outside guidelines both on the patient and the health system. If clinical concern was high, GPs used their knowledge of local systems to ensure patients were investigated promptly even when not meeting the age criteria. While most GPs interpret age criteria flexibly and follow their own judgement and experience when making clinical decisions regarding younger patients, system constraints may be a barrier to timely investigation.

SP6.3 Prognostic significance of Socio-Economic Deprivation on OGD outcome

Abstract Introduction Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on OesophagoGastroDuodenoscopy (OGD) findings has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of OGD irrespective of referral reason. Method Two-thousand consecutive patients presenting to four Health Boards in Wales (June 2019-) were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into Quintiles for analysis (Q1 most, Q5 least Deprived). Results Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Oesophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Oesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC) referral (n=35, 4.6%) with three diagnosed after routine OGD (0.6%, p<0.001). Deprivation was associated more advanced radiological perceived Stage III Cancer (Q1 16.1% v Q2 55.6% v Q5 5.6%, OR 0.007, p=0.005). Conclusion Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe oesophagitis, which correlated with up to 10-fold more advanced cancer stage at diagnosis.

Evaluating a novel patient pathway to manage symptomatic breast referrals (the blue flag clinic): a longitudinal observational study.

A novel referral pathway for exhibited breast symptom (EBS) referrals to manage increasing referrals of urgent suspected cancer (USC) was implemented in our trust. We report on the safety and effect on compliance with the 2-week-wait rule (2WW). A single-centre longitudinal observational study included all patients referred to a UK breast unit during 13 May 2019 to 27 March 2020 (period 1) and 8 February 2021 to 31 January 2022 (period 2). USC referrals were assessed in a one-stop clinic (red flag clinic [RFC]); EBS referrals were assessed in a new clinic in which clinical evaluation was performed and imaging occurred subsequently (blue flag clinic [BFC]). Patients were followed up to determine the symptomatic interval cancer rate. There were 9,695 referrals; 1,655 referrals (17%) were assessed in the BFC after 63 exclusions. Some 95.9% of patients had a benign clinical examination (P1/P2), 80.1% had imaging (mammogram or ultrasound) and 4% had a tissue biopsy. In total, 16/1,655 (0.97%) BFC patients and 510/7,977 (8.2%) RFC patients were diagnosed with breast cancer (breast cancer detection rate). Some 1,631 patients (with 1,639 referrals) were discharged and followed up for a median of 17 months (interquartile range 12-32) with one subsequent cancer diagnosis (symptomatic interval cancer rate, 0.06%). Implementation of the BFC pathway increased 3-month average trust performance of USC referrals with 2WW standard from 8.5% to 98.7% (period 1) and from 30% to 66% (period 2). The BFC pathway for EBS patients is safe and implementation led to improvement against the 2WW target for USC referrals, ensuring resources are prioritised to patients with the highest likelihood of breast cancer.

BT23 Outcomes of skin lesion referrals assessed via teledermoscopy

Abstract Skin lesion referrals from primary care comprise a significant proportion of the dermatology workload. Urgent suspected cancer (USC) referrals are prioritized, which adds strain to outpatient capacity and impacts on waiting lists for less urgent and routine referrals. Our department provides a teledermoscopy diagnostic service to allow for timely diagnosis of skin lesions. This results in fast detection of USC and a reduction in unnecessary hospital visits for patients with benign lesions. The aim of this study was to review the outcomes of USC and routine referrals received from primary care and assessed via our teledermoscopy service. We randomly selected 381 skin lesion referrals triaged for teledermoscopy between January and March 2022. In total, 189 (49.6%) of these were referred as routine and 192 (50.4%) were urgent/USC. High-resolution clinical and dermoscopic photographs of all skin lesions were taken by qualified clinical photographers and stored in the patients’ electronic records. Two separate consultant dermatologists reviewed the images along with the information provided in the referrals for diagnosis. A total of 47 diagnoses were observed in both cohorts. Only 16% of patients referred as urgent/USC had suspected high-risk cancer, including squamous cell carcinoma (SCC; 8.8%), melanoma (5.7%) and lentigo maligna (1.5%). The remainder of urgent/USC referrals were identified as nonurgent or benign, with an overwhelmingly low risk of basal cell carcinoma (23.9%), seborrhoeic keratoses (20.8%) and benign naevi (9.3%). For routine referrals, 11 patients (5.8%) were suspected to have USC. Of these, five had histological confirmation of melanoma (n = 3), SCC (n = 1) and melanoma in situ (n = 1). Of all referrals, 44.6% were reassured and discharged; 20.8% required clinic review for a diagnostic biopsy or treatment; 20.7% were booked directly for minor surgery; 8.3% were referred to the community local enhanced services for the treatment of low-risk lesions on the torso and limbs; 1.3% were referred to other specialties; and 4.1% required digital monitoring by repeating photographs 3–6 months later. An ever-increasing prevalence of skin cancer, together with suboptimal dermatology training for primary care healthcare professionals, anxiety over misdiagnosing malignancy and pressure from anxious patients all contribute to the pressure on dermatology services. We have shown that a teledermoscopy service is a useful tool for triaging skin cancer referrals to maximize the utilization of outpatient capacity and ensure timely treatment for patients with USCs.

P29 Selfies: not ideal!

Abstract We sought to determine whether the quality of photographic referrals from primary care had been impacted by the COVID-19 pandemic. A total of 2411 referrals made in 2020, 2021 and 2022 were retrospectively reviewed. From this, data were collected on urgent suspected cancer (USC) referrals (n = 1174) made between 1 January and 31 March. For each referral, the photographs included were reviewed. Eighty-four per cent of the 271 USC referrals made in 2020 included photos, 90.3% of the 413 referrals in 2021 and 91.2% of the 490 referrals in 2022. We devised criteria to determine quantitatively the quality of photographs based on the presence of a locator image, a close-up image, a ruler, a dermatoscopic image and whether the photos were in focus. Each feature scored 1, generating a quality score of 0–5. The mean quality scores in 2020, 2021 and 2022 were 2.16, 2.13 and 2.30, respectively. A Kruskal–Wallis test was performed to determine whether there was statistical significance to the differences seen between the sample groups. The alternative hypothesis was that the distribution of the quality scores across the sample groups was unequal. An overall P-value of 0.075 was generated, which was below the threshold of 0.1; therefore, the alternative hypothesis was accepted. On paired comparison between the sample groups, there was a statistically significant increase from 2021 to 2022, with an adjusted P-value of 0.069. We also subjectively judged whether the photos from each referral had made a positive impact on the final diagnosis. Seventy-five per cent (n = 170) of referrals in 2020, 251 (67.3%) in 2021 and 356 (79.6%) in 2022 included photos that had a positive impact on the final diagnosis. To conclude, our results showed that there was a significant decrease in the quality of photographs included in USC referrals in 2021 when compared with the sample groups of 2020 and 2022, suggesting that the COVID-19 pandemic had a negative impact on the triage of USC referrals from primary care. This could be explained by the reduction in face-to-face consultations and an increase in the number of patient-provided images. The results highlight that a significant proportion of images sent by general practitioners and patients are of insufficient quality for effective review and diagnosis. Possible solutions proposed include further provision of medical photography services and education. This work will be used as a baseline for the introduction of a teledermatology service.

Dental practice to dental hospital referrals—upgraded to urgent suspected cancer pathways: A three year service review

AbstractIntroductionInappropriate General Dental Practitioner (GDP) patient referrals may delay cancer diagnoses, increasing the risk of late‐stage presentation. Urgent suspected cancer (USC) referrals from GDPs are reviewed swiftly by clinicians. Non‐USC referrals may wait up to a week before being reviewed by clinicians.Aims and objectivesTo investigate upgraded‐to‐USC GDP referrals to a University Dental Hospital (UDH) following the establishment of the pan‐Wales electronic referral management system (e‐RMS) in 2019. To examine reasons for their upgrade to the USC pathway, and to assess diagnostic outcomes, diagnostic delay and compliance with The National Institute for Health and Care Excellence (NICE) referral recommendations.MethodologyUpgraded‐to‐USC e‐Referrals were reviewed and cross‐referenced against the electronic patient management system and patient files to assess waiting times from referral date to first appointment. Each e‐Referral was reviewed to determine the reason for upgrade to a USC referral. Patient outcomes and diagnoses were also examined.Results83 patient records were identified. Upgraded e‐Referrals accounted for 18.6% of all USC e‐Referrals. The majority of upgraded e‐Referrals (66.3%) were upgraded because they included words describing key malignancy features. Malignant and oral potentially malignant disorders (OPMDs) accounted for 3.8% and 17.5% of diagnostic outcomes respectively. Overall, 18.8% of upgraded‐to‐USC e‐Referrals did not meet the NICE guideline requirement of having a first appointment within 2 weeks.ConclusionEarly diagnosis of malignancies is fundamental in improving oral cancer survival outcomes. Some GDPs' clinical judgement and referral pathway choice needs improvement. Reinforcing GDP education in regard to USC referrals will likely reduce inappropriate referrals.

A novel blood based triage test for colorectal cancer in primary care: a pilot study.

The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is a pressing need for access to simple triage tools in primary care to help prioritise patients for referral. To evaluate the performance of a novel spectroscopy-based CRC blood test in primary care. Mixed-methods pilot study of test performance and GP focus group discussions in South Wales. Patients on the urgent suspected cancer (USC) pathway were recruited for the Raman spectroscopy (RS) test coupled to machine learning classification ('Raman-CRC') to identify CRC within the referred population. Qualitative focus group work evaluated the acceptability of the test in primary care by thematic analysis of focus group theorising. A total of 532 patients aged ≥50 years referred on the USC pathway were recruited from 27 GP practices. Twenty-nine patients (5.0%) were diagnosed with CRC. Raman-CRC identified CRC with sensitivity 95.7%, specificity 69.3% with area under curve (AUC) of 0.80 compared with colonoscopy as the reference test (248 patients). Stage I and II cancers were detected with 78.6% sensitivity. Focus group themes underlined the convenience of a blood test for the patient and the test's value as a risk assessment tool in primary care. The findings support this novel, non-invasive, blood-based method to prioritise those patients most likely to have CRC. Raman-CRC may accelerate access to diagnosis with potential to improve cancer outcomes.

835 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in Ruling Out Primary Bowel Cancer: A Review of Current Outcomes

Abstract Aim NICE recommends a FIT <10 may not warrant an Urgent Suspected Cancer(USC) Referral. We aim to assess current outcomes at a local level. Secondary aims included whether a high FIT(>100) determines increased cancer risk and whether a moderate FIT(10–100) warrants a USC referral. Method We retrospectively looked at patients who received a FIT between June-December 2020 in North-West Wales. These were divided into 3 groups: negative FIT(<10), moderate FIT(10–100) and high FIT(>100). They were followed-up for a year to determine the result of further investigations such as Endoscopies, CT Colons or CTs. The histology results from polyps/biopsies/specimens from Endoscopy/Surgery were recorded. Results A total of 909 patients received a FIT, 180 excluded due to no result. 557 were negative, 125 moderate and 47 high. 2 of 557(0.36%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 4 of 125(3.2%) in the moderate FIT group and 10 of 47(21.27%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 1(2.13%) in the high, 3(2.4%) in the moderate and 0 in the negative Group. Conclusions Inappropriate investigations and delayed diagnosis can both have drastic clinical and financial implications. Our results show that a negative FIT, with a thorough history and examination, should prevent a need for a USC referral for primary bowel cancer. Patients with high FIT could proceed to investigation, while moderate FIT may need further assessment.

SP9.1.3 Colorectal Cancer Referrals During COVID-19: The Use of CT and qFIT in Triaging Patients in NHS Grampian

Abstract Introduction The COVID-19 outbreak resulted in fundamental changes to clinical practice for patients referred to secondary care with lower gastrointestinal symptoms. The use of colonoscopy services was reduced due to a perceived risk of viral transmission. Resultantly, computed tomography abdomen pelvis (CTAP) scans were utilised to triage patients. This study aimed to assess the accuracy of CTAP and qFIT in triaging patients at risk of colorectal cancer. Methods This study retrospectively gathered data on patients referred via the urgent suspected cancer (USC) pathway from the start of lockdown over a 6-month period in a single Scottish Health Board. Data were collected on presenting symptoms, qFIT levels, vetting decision, investigations, and subsequent diagnosis. Patients were vetted into one of five pathways: CTAP, direct to colonoscopy, downgraded from assessment, flexible sigmoidoscopy, or CT colonography. Results The overall cancer detection rate was 6.4%. Of the patients with cancer on the CTAP pathway, 22.9% had cancer undetected on CTAP which was later identified on colonoscopy. In the cohort of patients with colorectal malignancy, 7.5% had a negative qFIT value (<10 ug/g). Conclusion CTAP alone may not be accurate in detecting colorectal cancers. One should consider the whole clinical picture and decide whether further imaging is warranted following a negative CTAP scan. Additionally, qFIT remains the leading laboratory investigation within screening programmes, however, it should not be used in isolation to rule out colorectal malignancy.

SPOD3 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in ruling out Primary Bowel Cancer: A review of current outcomes.

Abstract Aim NICE recommends that a FIT <10µgHb/g may not warrant an Urgent Suspected Cancer (USC) Referral. Our primary aim was to assess outcomes at a local level for FIT <10µgHb/g. Secondary aims included whether a high FIT(>100µgHb/g) determines increased cancer risk and whether a moderate FIT(10–100µgHb/g) warrants USC inv: estigations. Methods A retrospective review of all symptomatic patients who received a FIT in a District General Hospital in North Wales between June-December 2020. These were divided into 3 groups: negative FIT(<10µgHb/g), moderate FIT(10–100µgHb/g) and high FIT(>100µgHb/g). The results of any subsequent investigations such as Endoscopies, CT Colons or CTs were recorded along with the histology results from polyps/biopsies/specimens from Endoscopy/Surgery. Simple sensitivity and negative predictive value(NPV) analyses were performed. Results A total of 722 patients returned a FIT result. 544 were negative, 106 moderate and 72 high. 2/544(0.37%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 3/106(2.83%) in the moderate FIT and 15/72(20.83%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 2(2.78%) in the high, 2(1.89%) in the moderate and 0 in the negative group. FIT sensitivity of 90% and NPV of 99.62% was demonstrated. Conclusions A negative FIT can adequately exclude primary bowel cancer in symptomatic patients. Patients with high FIT could proceed “straight-to-test”, while moderate FIT may need further outpatient assessment. Inappropriate investigations and delayed diagnosis have drastic clinical and financial implications.

Adapting the investigation of patients on urgent suspected cancer pathway with lower gastrointestinal symptoms across Wales during COVID-19.

The COVID-19 pandemic necessitated the introduction of revised diagnostic pathways for assessing urgent suspected cancer (USC) referrals. Combinations of faecal immunochemical testing (FIT) and minimal preparation computed tomography (CT) scans (MPCT) were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways across Wales is evaluated in this study. All consecutive patients referred from primary care on the USC pathway between 15 March and 15 June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90days following initial referral. A total of 1,050 patients across eight sites in Wales were included. Of these 1,050 patients, 52.6% were female with median age 68 (21-97) years; 50.5% had first-line clinical review, of which 61.1% were virtual consultations; 49.5% had primary investigations; 26.7% of patients had FIT and 13.1% had MPCT. COVID-response pathways achieved a 29.9% reduction in use of colonoscopy as first-line investigation and 79% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 6.8% of USC referrals were diagnosed with colorectal cancer (CRC). Median timescale from diagnosis to treatment for CRC was 65 (4-175) days. The negative predictive value (NPV) for FIT in this cohort was 99.6%. MPCT as the first modality had a NPV of 99.2%. A modified investigation pathway helped maintain cancer diagnosis rates during the pandemic with improved resource utilisation to that used prepandemic.

Development and validation of multivariable machine learning algorithms to predict risk of cancer in symptomatic patients referred urgently from primary care: a diagnostic accuracy study

ObjectivesTo develop and validate tests to assess the risk of any cancer for patients referred to the NHS Urgent Suspected Cancer (2-week wait, 2WW) clinical pathways.SettingPrimary and secondary care, one...

Improving access to neck ultrasound referral and using guidance as a means of reducing demand on neck lump specialist assessment clinics

Background: As with many services across the NHS, specialist clinics for the assessment of neck lumps are under increasing pressure. These clinics are ideally reserved for urgent suspected cancer (USC) referrals. However, confirmation of normal anatomy or benign pathology contributes to a considerable proportion of clinical resources. Neck ultrasound (NUS) is the primary imaging modality in assessment. In NHS Grampian, referral for NUS has historically not been widely publicised to general practitioners (GPs), with patients typically referred via the head and neck (H&N) service. This study aimed to reduce patient footfall to H&N clinics by improving GP direct access to NUS. This could reduce the number of patient hospital attendances; with a single NUS appointment replacing a clinic attendance, an NUS appointment and a clinic review for discussion of results and management.

SP4.1.5The use of Faecal Immunochemical Testing (FIT) and Minimal Preparation Computed Tomography (MPCT) during COVID-19 for Urgent Suspected Cancer (USC) referrals in patients with lower gastro-intestinal symptoms

AimsThe COVID-19 pandemic necessitated introduction of revised diagnostic pathways for assessing Urgent Suspected Cancer (USC) referrals. Combinations of FIT and MPCT were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways are evaluated in this study.MethodsAll consecutive patients referred from primary care on the USC pathway between 15th March – 15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral.Results816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 – 97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to-face consultations altogether during this first wave of the pandemic.Overall, 5.6% of USC referrals were diagnosed with CRC. Median timescale from diagnosis to treatment for CRC was 82 (4 – 175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%.ConclusionA modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.

Mouth Cancer – Risk Factors and Potentially Malignant Disorders

The incidence of mouth cancer in the UK has increased more than 30% during the past decade and the overall 5-year survival remains poor, at approximately 55%. A number of risk factors for mouth cancer has been identified, and all dental professionals should be aware of these, and, where possible, provide intervention. Some cases of mouth cancer arise in a pre-existing mucosal condition, known as an oral potentially malignant disorder (OPMD). Awareness of the presence of an OPMD, or any mucosal changes that fulfil the criteria for urgent suspected cancer (USC) in primary care, should lead to an appropriate referral to specialist services. CPD/Clinical Relevance: This paper provides a review of the risk factors for mouth cancer and potentially malignant disorders.

Cancer diagnosis in Scottish primary care: Results from the National Cancer Diagnosis Audit.

To characterize cancer diagnosis in Scottish primary care and draw comparisons with cancer diagnostic activity in England. A national audit of cancer diagnosis was conducted in Scottish and English general practices. Participating GPs collected diagnostic pathway data on patients diagnosed in 2014 from medical records. Data were supplemented by linkage to national cancer registries. Analysis explored and compared patient characteristics, diagnostic intervals, and routes to diagnosis. 7.7% of all Scottish general practices in 2017 provided data on 2,014 cancer diagnoses. 71.5% of cases presented to GPs and 37.4% were referred using the "Urgent-Suspected Cancer" route. The median primary care interval was 5days (IQR 0-23days) and median diagnostic interval was 30days (IQR 13-68). Both varied by cancer-site. Diagnostic intervals were longer in the most remote patients and those with more comorbidities. Scottish and English samples corresponded closely in key characteristics. Most people diagnosed with cancer in Scotland present to a GP first. Most are referred and diagnosed quickly, with variations by cancer-site. Intervals were longest for the most remote patients. GPs in Scotland and England appear to perform equally but, in view of growing differences between health systems, future comparative audits may be informative.

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study.

BackgroundA pilot rapid diagnosis centre (RDC) allows GPs within targeted clusters to refer adults with vague and/or non-specific symptoms suspicious of cancer, who do not meet criteria for referral under an urgent suspected cancer (USC) pathway, to a multidisciplinary RDC clinic where they are seen within 1 week.AimTo explore the cost-effectiveness of the RDC compared with standard clinical practice.Design and settingCost-effectiveness modelling using routine data from Neath Port Talbot Hospital, Wales.MethodDiscrete-event simulation modelled a cohort of 1000 patients from referral to radiological diagnosis based on routine RDC and hospital data. Control patients were those referred to a USC pathway but then downgraded. Published sources provided estimates of patient quality of life (QoL) and pre-diagnosis anxiety. The model calculates time to diagnosis, costs, and quality-adjusted life years (QALYs), and estimates the probability of the RDC being a cost-effective strategy.ResultsThe RDC reduces mean time to diagnosis from 84.2 days in usual care to 5.9 days if a diagnosis is made at clinic, or 40.8 days if further investigations are booked during RDC. RDC provision is the superior strategy (that is, less costly and more effective) compared with standard clinical practice when run near or at full capacity. However, it is not cost-effective if capacity utilisation drops below 80%.ConclusionAn RDC for patients presenting with vague or non-specific symptoms suspicious of cancer in primary care reduces time to diagnosis and provides excellent value for money if run at ≥80% capacity.

Evaluation of a national lung cancer symptom awareness campaign in Wales

BackgroundLung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes.MethodsPopulation-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods.ResultsIncreased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis.ConclusionsSymptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects.