A significant proportion of cancer patients across Europe are diagnosed with their disease as the result of an emergency presentation (EP) to acute secondary care services. This route to diagnosis is associated with poorer survival and worse patient experience. Previous work has shown that EP patients usually describe a long history of symptoms (>12 weeks), and that 70% had seen their general practitioner (GP) in the days and weeks prior to presentation. Tackling EP of cancer is important when improving the outcomes of patients across Europe. In the majority of cases there are opportunities for earlier diagnosis and hence prevention of EP.
We ran a 1-year pilot of a nurse-led Acute Diagnostic Oncology Clinic (ADOC) in a district general hospital. Based in the oncology department with consultant supervision of every case, the service was targeted at primary care. Referral criteria: age >18 years, clinical or radiological suspicion of cancer, clinically unable to wait 2 weeks for a standard urgent suspected cancer referral. Patient demographics, clinic activity, investigations and diagnoses were recorded. Formal patient and GP feedback was sought from all users.
Seventy-seven referrals were received, of which 46 (60%) fulfilled the criteria and were accepted. All were seen within 24 hours of referral. Median time from referral to definitive diagnostic test was 7.4 days (range 1-19), and 22 patients (48%) were diagnosed with cancer. Eleven patients (24%) required non-elective hospital admission. An average of 1.43 radiological and 0.20 endoscopic investigations were undertaken per patient, of which 58% were completed at the first clinic visit. A wide range of cancer diagnoses were made, including lung, myeloma, gastrointestinal, breast and lymphoma. Two patients declined or were too unwell to undergo biopsy. Patient and GP feedback showed a high level of user satisfaction.
ADOC is a novel, effective and efficient pathway for patients who might otherwise be diagnosed as part of EP. This pilot shows the feasibility of a nurse-led service based in an oncology department, and a high level of user satisfaction. This model of acute diagnostic oncology clinic should be considered as an addition to existing outpatient cancer diagnostic pathways.
Clinical trial identification
Legal entity responsible for the study
Chelsea & Westminster Hospital NHS Trust
Cancer Research UK Macmillan NHS England
All authors have declared no conflicts of interest.