Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation

Journal article

Background: Although less common cancers account for almost half of all cancer diagnoses in England, their relative scarcity and complex presentation, often with non-specific symptoms, means that patients often experience multiple primary care consultations, long times to diagnosis, and poor clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem.
Aim To examine the less common cancers identified during the MDC pilots and consider whether such an approach improves the diagnosis of these cancers.
Design and setting A service evaluation of five MDC pilot projects in England from December 2016 to March 2019.
Method Data items were collected by pilot sites in near-real time, based mainly on the English cancer outcomes and services dataset, with additional project-specific items. Simple descriptive and comparative statistics were used, including χ2 tests for proportions and t-tests for means where appropriate.
Results From 5134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. More than 30 different less common tumour types were diagnosed in this cohort. Of the MDC patients with less common cancers, 23% (n = 50) had ≥3 GP consultations before referral and, at programme level, a median time of 57 days was recorded from GP urgent referral to treatment for these tumour types.
Conclusion A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.

Authors: Chapman, D; Poirier, V; Fitzgerald, K; Nicholson, BD; Hamilton, W

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: British Journal of General Practice
• Volume: 71
• Issue: 712
• Pages: e846-e853
• Publication date: 2021-06-04
• Acceptance date: 2021-04-07
• DOI: 10.3399/bjgp.2020.1108
• EISSN: 1478-5242
• ISSN: 0960-1643
• Pmid: 34097639
• Language: English
• Keywords: ACE MDC projects; urgent cancer referral; less common cancers; MDC; non-specific symptoms; primary health care; Multi-disciplinary Diagnostic Centre; FFR