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

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 clinica...

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Autores principales: Chapman, Dave, Poirier, Veronique, Fitzgerald, Karen, Nicholson, Brian D, Hamilton, Willie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463131/
https://www.ncbi.nlm.nih.gov/pubmed/34097639
http://dx.doi.org/10.3399/BJGP.2020.1108
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author Chapman, Dave
Poirier, Veronique
Fitzgerald, Karen
Nicholson, Brian D
Hamilton, Willie
author_facet Chapman, Dave
Poirier, Veronique
Fitzgerald, Karen
Nicholson, Brian D
Hamilton, Willie
author_sort Chapman, Dave
collection PubMed
description 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 χ(2) 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.
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spelling pubmed-84631312021-10-18 Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation Chapman, Dave Poirier, Veronique Fitzgerald, Karen Nicholson, Brian D Hamilton, Willie Br J Gen Pract Research 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 χ(2) 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. Royal College of General Practitioners 2021-09-21 /pmc/articles/PMC8463131/ /pubmed/34097639 http://dx.doi.org/10.3399/BJGP.2020.1108 Text en © The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Research
Chapman, Dave
Poirier, Veronique
Fitzgerald, Karen
Nicholson, Brian D
Hamilton, Willie
Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
title Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
title_full Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
title_fullStr Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
title_full_unstemmed Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
title_short Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
title_sort non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463131/
https://www.ncbi.nlm.nih.gov/pubmed/34097639
http://dx.doi.org/10.3399/BJGP.2020.1108
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