Introduction Late diagnosis is thought to be a significant cause of the observed lower cancer survival in UK compared to equivalent countries worldwide. A significant proportion of patients with intra-abdominal cancer are often diagnosed after attending Emergency Departments with late stage disease, highlighting the fact that often symptoms of early upper gastrointestinal (UGI) cancer are nebulous and ill-defined.
Methods A pilot Multidisciplinary Diagnostic Centre (MDC) at UCLH was established in June 2015. The MDC is for: (a) patients with severe but non-specific worrying symptoms, warranting rapid diagnosis but not qualifying for a ‘2 Week Wait’ referral; (b) patients with severe symptoms for whom admission to hospital currently offers the only clinically appropriate route to timely care. The Centre aims to provide rapid access to specialist assessment and appropriate diagnostic tests, leading to a defined management plan within 28 days of referral, aligning to the Independent Cancer Taskforce recommendations. Initial assessment is by a clinical nurse specialist (CNS) with consultant support. Once the diagnostic tests are performed, follow up is by face to face consultant assessment. Feedback to the service was elicited by a series of phone calls to a proportion of referring doctors.
Results Of the initial 91 patients, the majority of patients (47%, 43) presented with vague abdominal symptoms alone. A further 24% (22) of patients had unexplained weight loss. 93% of patients were offered an initial appointment to MDC within 5 working days. Relevant eventual clinical diagnoses were cancer of unknown primary (1), pancreatic cancer (1), adrenal adenoma (1) and intraductal papillary mucinous neoplasm of pancreas (1). Other non-cancer diagnosis include hiatus hernia (10%), irritable bowel syndrome (8%), and colonic/rectal polyp (5%). The majority of patients underwent CT scanning (54%) and UGI endoscopy (39%). Primary care feedback (n = 6) highlighted the importance even of non-cancer diagnoses.
Conclusion The ability to provide a rapid access diagnostic clinic is feasible and will enable the NHS to achieve the Independent Cancer Taskforce recommendation on providing a definitive cancer diagnosis, or cancer excluded within 28 days. Cancer rates are in keeping with other cancer pathways. Input from CNS and efficient administration support are essential in ensuring the diagnostic journey is centred around the patients. We need to understand more about patient experience in this novel pathway, in particular whether rapid access to diagnostic tests and specialist opinion is being perceived as an excellent service.
Disclosure of Interest None Declared