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Two consultants from the University College London Hospital (UCLH) Cancer Collaborative – one of the Cancer Vanguard partners – talk about the work they have been doing to improve diagnosis for suspected cancer patients:
Cancer survival rates in England are higher than they have ever been and earlier diagnosis is the key to improving survival rates further.
At UCLH Cancer Collaborative we recognised there was scope for bridging the gaps in diagnosis. Patients with suspected cancer should all get an urgent referral within two weeks but research shows that only 40% to 45% of patients are diagnosed through this pathway. Others are diagnosed in A&E or in other hospital wards.
Other analysis on cancer patients presenting symptoms in primary care has shown that more than half did not have symptoms in their medical notes that met the NICE guideline for suspicion of cancer. So patients with non-specific but concerning symptoms, such as weight loss and abdominal pain, where the GP suspects cancer, do not have an effective diagnostic pathway.
These patients find themselves going back and forth between GP surgeries and hospital clinics before a diagnosis can be made. Diagnosis takes longer and treatment, which is more effective the earlier we catch the cancer, takes longer too.
As part of the Cancer Vanguard, we have set up Multidisciplinary Diagnostic Centre (MDC) pilots in various parts of the country to deliver a clearly defined and structured diagnostic pathway for patients with abdominal or vague symptoms, where the GP or hospital consultants require quick and profound investigation of patients with non-specific serious symptoms.
We designed the centre to improve patient flow, avoid unnecessary hospital admissions and improve patient experience and outcomes through faster diagnosis.
The concept of MDCs began in Denmark after they recognised that simply having an urgent referral pathway was insufficient to address timely diagnosis of all cancer patients. The evaluation in Denmark is ongoing but remains very positive.
In England, the pilot MDCs are part of the ACE (Accelerate, Co-ordinate and Evaluate) Early Diagnosis Programme, jointly funded by Cancer Research UK, Macmillan and NHS England.
Each MDC has a dedicated team of clinicians, including nurse specialists, who can provide a fast-track diagnostic service for patients who are traditionally difficult to diagnose.
Nurse specialists then provide telephone support from the point of referral, when cancer is suspected but not yet confirmed.
Our MDCs are seeing referrals from GPs rise with a 106% increase between August 2016 and September 2017 and our London sites are reporting more accurate and much faster diagnosis. Of the patients seen by the MDCs, 8% have been diagnosed with cancer and 15% have a significant non-malignant diagnosis (other serious medical conditions). Patient feedback has been very positive, with learning on how the service can improve.
The signs are promising but it is still too early to say what impact this service has had system-wide. The Danish model has reported falls in unplanned admissions and emergency attendance, fewer repeat visits to GPs, and earlier diagnosis of cancer and other complex, long-term conditions.
We hope that the greater the focus on early diagnosis, the higher will be the chances of patients recovering well and living longer.