Evaluation of a cancer of unknown primary (CUP) service – the first two years


Year:

Session type:

T. Tillett1, A. Kuchel1, L. Medley1
1Royal United Hospital, Bath, UK

Background

Cancer of Unknown Primary (CUP) is a challenging tumour site because of the heterogeneity of the patients and tumours, inherent nihilism, and lack of clear evidence based guidelines. Following publication of the National Institute of Clinical Excellence (NICE) guidelines on the management of CUP in July 2010 we have taken steps to try to improve our current services and outcomes for these patients.

Method

The Royal United Hospital (RUH) Bath is a busy district general hospital with an integral oncology unit and a dedicated CUP oncology consultant. All patients with a diagnosis of provisional CUP were added to a prospective database and information was collected on imaging, biopsies, multidisciplinary team meeting (MDM) discussions as well as primary treatment and outcome.

Results

117 patients have been registered on the CUP database between January 2010-12. Of these, 38% had confirmed CUP, 48% had a primary site identified (e.g. 6% colorectal, 5% lung, 3% gynaecology, 3% prostate, 3% breast). Patients were discussed at a variety of MDMs as the CUP MDM is still being set up (48% Upper GI, 17% lung, 9% haematology, 8% urology). The majority of referrals were seen as outpatients, 39% as a result of MDM discussions and 24% from direct GP referrals (half of these via the two week wait pathway). The remainder (30%) were inpatient referrals. Primary treatment included best supportive care (40%), chemotherapy (25%), radiotherapy (7%) and surgery (3%). Of those treated with treated with chemotherapy 4% had a complete response, 61% partial response, 30% progressive disease and 5% died on treatment.

Conclusion

There have been advances in the care of patients with CUP, now with dedicated team members, more optimism about management and earlier input of specialist advice.Improvements still need to be made with a more coordinated structure of vital services and research to move treatment and outcomes forward in line with other tumour sites.