One Year Results from a South Wales Rapid Diagnostic Clinic for Patients with Serious but Non-Specific Symptoms of Cancer


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Kieran Foley1,Balan Palaniappan2,Anthony Gibson2,Gareth Davies2
1Cardiff University,2Cwm Taf University Health Board

Abstract

Background

Cancer is a leading cause of death in the UK. Initiatives such as the 2 week wait (2-WW) and Urgent Suspected Cancer (USC) pathways in Wales have been implemented to expedite investigations for patients with red-flag symptoms. However, only 50% of patients diagnosed with cancer have such symptoms. Approximately 20% of patients have serious but non-specific symptoms, such as nausea and weight loss. These patients often experience diagnostic delays. Here, we present results from the first 12 months of a rapid diagnostic clinic (RDC) aiming to investigate patients with serious but non-specific symptoms of cancer.

Method

This is an ongoing prospective population-based interventional study. Patients with serious but non-specific symptoms of cancer who do not qualify for a particular diagnostic pathway were referred to the RDC directly from a GP between 18th July 2017 and 17th July 2018. Forty-two practices covering a population of approximately 301,000 patients were invited to participate. Following initial GP consultation and blood tests, consultant review was performed in the RDC and appropriate radiological investigations requested. The CT was performed and reported by a consultant radiologist on the same day. The primary outcome was the conversion rate.

Results

In 12 months, 259 patients (median age 69.2 years, range 35-94, females 151) were recruited. Twenty-five cancers were diagnosed, a conversion rate of 9.7%. Lung cancer was the most frequent malignancy (n=6). Overall, 76% of patients were stage 4. The most common presenting symptom was weight loss (77%). One hundred and thirty-eight patients (53.3%) were seen within 1 week of GP referral.

Conclusion

These results highlight the potential benefit of a RDC investigating patients with serious but non-specific signs of cancer. This rate was higher than the USC conversion rate in our health board (3-8%). Such diagnostic interventions should be considered to improve conversion rates in this particular patient group.