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PTU-070 Flying off course with a 2ww direct access pilot: nottingham’s experience of the suspected upper gastrointestinal cancers pathway change with gp vetting and ogd booking
  1. NR Lewis,
  2. J Catton,
  3. E James
  1. Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK

Abstract

Introduction Timely progress through diagnostic pathways is a leading quality measure for NHS cancer services. A hypothesis of sooner diagnosis being achievable with direct access to hospital tests from primary care is a core part of CRUK ACE program (1), and in the context of UGI cancer pathway, there is known wide variation of direct access (DA) OGD (2). This pilot evaluates the efficacy and utility of DA OGD or clinic (DA OPD) for GP concerns a patient may have OG cancer. Comparison was made with the standard 2WW pathway, where allocation to OGD v OPD first is performed by OG consultant.

Method Pilot and UGI standard 2WW referrals 01/01-01/08/16 were identified from Cancer Centre records.

Results 192 patients were in the pilot pathway, 430 via the standard 2WW. GPs were more likely to allocate patients to DA OGD (52%) compared to 32% having DTT OGD allocated by the hospital. Despite under-utilisation of protected slots for DA OGD, time to DA OGD compared to DTT did not differ (11.0d, 95% CI 10.5,11.2 v 12.4d, 95% CI 11.0,13.9). The same was seen for DA OPD. The total time on pathway was not improved in the pilot group at 16.8d (95% CI 4.9,28.6) compared to 17.9d (95% CI 16.9, 18.9). The subgroup of patients allocated in the pilot to DA OGD did have a quicker exit from the pathway, at 12.4d (95% CI 6.5,18.3) compared to 14.8 (95%CI 12.9,16.6) on the DTT OGD group. The pilot overall detected 8 cancers (4.2%); the standard 2WW path detected 55 (12.8%). OG cancers were in 4 of the DA OGD (4%) and 14 of the DTT OGD (10.2%). A further 10 non-OG cancers were detected in the DTT group after clinicians requested further investigations to determine the cause of their symptoms. Those patients allocated to OPD first by either GP or hospital were as likely to have cancer as those having OGD, with 4.3% of those in the pilot having a cancer detected this way, but none OG cancer, and 10.3% found to have cancers in the standard 2WW group following investigation directed after clinic visit. Of these 65% were cancers other than OG cancers and would not be detected on OGD alone.

Conclusion OGD as a sole investigation for symptoms has its utility in excluding or detecting OG cancer. A high proportion of cancers detected via 2WW criteria on OG pathway are outside of OG tract and require other tests to diagnose them. In this pilot no additional utility of opening direct access OGD for GP concerned a patient may have an OG cancer was not demonstrated unless exclusion of OG cancer is viewed as the major purpose of the pathway. Our data demonstrates that such a view would be detrimental and lead to missed opportunity to detect other cancers that cause symptoms overlapping with those often ascribed to OG tumours.

References

  1. . www.cancerresearchuk.org

  2. . PLoS ONE11(7):e0159725.

Disclosure of Interest None Declared

  • Cancer
  • Commissioning
  • direct access

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