Background

The RDS is a referral pathway for patients with symptoms concerning for cancer that do not fulfil tumour-specific two-week-wait criteria. In response to the COVID-19 pandemic, we established a virtual triage system to prioritise patients’ straight to test (STT) or clinical review. Those of lower clinical need were returned to the GP with advice on their management.

Method

We evaluated all patients referred to Guy’s RDS COVID-19 virtual triage scheme between 1^st March– 31^st August 2020 (n=419). The primary aim to assess the cancer detection rate. Secondary aims to assess RDS clinical effectiveness including times to first RDS appointment, cancer diagnosis and treatment

Results

Of 529 patients referred to Guy’s RDS, 59.2% were seen face-to-face, 21.5% sent STT, 13.1% had their care returned to their GP and 4.3% were rejected. The median age was 63 years (IQR 51-75) and 42.3% were male. Commonest ethnic backgrounds were White-British 28.9%), Black-British (14.6%).  37 cancers were detected giving a cancer detection rate of 7.8% of patients seen in the RDS.  The commonest tumours were breast (24.3%), upper-gastrointestinal (16.2%) and lung (13.5%) with 75.7% being stage IV. The median time from RDS to histological cancer diagnosis was 13days (IQR 7-24 days) and 28 days (IQR 10.5-52 days) to treatment. The median time from GP referral to RDS appointment was 13 days (IQR 8-16 days). 

Conclusion

The virtual triage prioritised 80% of patients referred to the clinic. Patients had similar demographics compared to pre-COVID except a higher proportion of men 58.47% (vs 40.8%). Cancer conversion rate increased 13% (vs 7.2%) with a marked shift in tumour types detected and an increase in the proportion of metastatic disease. Time to cancer diagnosis was significantly reduced to 13 days (vs 28 days). This audit demonstrates the benefit of a virtual triage system as a means to prioritising higher risk patients into the RDS.

Impact statement

Virtual clinics may prove imperative in managing the backlog of undiagnosed cancer patients, especially in the event of a second COVID-19 peak.