Introduction Around 9000 new cases of oesophageal cancer are diagnosed each year,a 43% increase over the last 40 years .1 Currently 80% of these are stage III or IV at diagnosis.A dedicated nurse led dysphagia clinic was established to reduce the referral to diagnosis time and to improve patients’ experience.Gwynedd is a district general hospital in north wales serving a population of 2 25 000 spread across 1260 square miles.
Method Over 13 months,referrals were vetted and those with dysphagia selected.200 patients attended a nurse endoscopist led clinic in the morning and underwent diagnostic endoscopy the same afternoon.The CSN (cancer specialist nurse) was available to see those diagnosed with malignancy,give contact details and appointments for further investigations were made the same day.Comparative data was retrospectively collected from the cancer services database for all oesophageal cancers diagnosed during the same time period via other pathways.
Results Data collected included referral to diagnosis time,endoscopic diagnosis and histology,performance status,staging and treatment.Questionnaires were given to those attending the one stop clinic assessing their patient experience.33 patients were diagnosed with oesophageal cancer,with equal numbers in each group.The average time from referral to diagnosis was 5.75 days for group A (dysphagia clinic) and 15.5 days for group B (other routes).50% of patients in group A were TNM stage I or II and 50% III or IV compared to 29% of patients in group B and 71% respectively.All patients in group A had a performance status recorded compared to 59% in group B.Curative treatment was the outcome of MDT for 56% of patients in group A and 38% group B.This is likely to reflect the non specific symptoms patients in group B present with leading to a delay in referral.
Conclusion Patients rated the dysphagia clinic 0–5, 72% scored 5/5% and 27% 4/5.Patients were complimentary of the service with comments “excellent, friendly staff, needing to take fewer days off work, less anxiety waiting for a diagnosis”. The reduction in number of visits to the hospital was a benefit mentioned by many, reflecting the large distance travelled.Our pilot demonstrates that streamlining those with dysphagia into a one stop clinic is advantageous. Fewer journeys and days off work are needed and patient satisfaction is high.A history is taken including performance status informing discussions at MDT and taking into account patients’ wishes. A rapport is built with staff making breaking bad news a better experience for the patient.The referral to diagnosis time is significantly reduced.The proportion of patients diagnosed with TNM stage I or II (50%) is significantly higher than the average of 21%–30%.1Further studies into other red flag symptoms yielding a high number of oesophageal cancer diagnoses will be done to included in future referral screening hopefully leading to earlier diagnoses.
Disclosure of Interest None Declared
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