Abstract 4433
Background
Cancers presenting with ‘vague symptoms’ are difficult to diagnose. These non-specific but serious symptoms (weight loss, anorexia, pain, fatigue) have a number of causes including malignancy. The risk for each individual cancer may be low, but the total risk of cancer of any type is higher. Patients diagnosed with cancer as the result of an emergency presentation (EP) to secondary care have poorer survival, usually describe a long history of symptoms, and most have seen their general practitioner (GP) prior to presentation. Earlier diagnosis improves cancer outcomes. But investigating vague symptoms is challenging, requiring both oncology and general medical knowledge, while bespoke rapid-access oncology diagnostic clinics are needed to avoid EP.
Methods
The Acute Diagnostic Oncology Clinic was established at Chelsea & Westminster Hospital in 2016. It initially provided rapid access investigations for those too ill to wait for an urgent suspected cancer appointment, as an alternative to the Emergency Department (ED). In February 2018 the clinic expanded to, uniquely, include a GP with specialist interest in oncology and patients with ‘vague symptoms’.
Results
361 referrals were received, 65% were female. Weight loss was the commonest vague symptom (50%). Initially, 96% of patients were seen within 24 hours of referral, falling to 69% after expansion of the clinic remit in 2018. 34% of patients (from 2018, 21%) were diagnosed with cancer. Mean time from referral to diagnosis was 4 days, and to starting cancer treatment it was 20 days. A range of cancers were identified, lung the commonest, and advanced stage disease the most likely. A number of significant non-malignant conditions were diagnosed. One-third of patients provided feedback. Only 37% were told at referral that cancer was suspected. The service was rated Excellent or Very Good in all cases. 84% valued being seen urgently. Feedback was received from 40 GPs. 100% would use the service again. Alternate referral routes would have been routine cancer referral (60%) or ED (13%).
Conclusions
To our knowledge, this is the only GP-oncology led rapid access cancer diagnostic clinic. Combining general medical and oncology expertise is an effective approach for diagnosing patients with vague symptoms and tackling EP cancer.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
CW+ Healthcare Charity.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
4614 - Predictors of Response to Checkpoint Inhibitors in Naïve and Ipilimumab-Refractory Melanoma
Presenter: Domenico Mallardo
Session: Poster Display session 3
Resources:
Abstract
2901 - IFN-γ/IL-10 ratio as predictive biomarker for response to anti-PD-1 therapy in metastatic melanoma patients
Presenter: Emilio Giunta
Session: Poster Display session 3
Resources:
Abstract
2306 - Multiplex Chromogenic Immunohistochemistry (IHC) for Spatial Analysis of Checkpoint-Positive Tumor Infiltrating Lymphocytes (TILs)
Presenter: Scott Ely
Session: Poster Display session 3
Resources:
Abstract
1678 - The role of PD-L1 expression as a predictive biomarker in advanced renal cell carcinoma: a meta-analysis of randomized clinical trials.
Presenter: Alberto Carretero-Gonzalez
Session: Poster Display session 3
Resources:
Abstract
5138 - Radiomic Features as a Non-invasive Biomarker to Predict Response to Immunotherapy in Recurrent or Metastatic Urothelial Carcinoma
Presenter: Kye Jin Park
Session: Poster Display session 3
Resources:
Abstract
5800 - Integrative combination of high-plex digital profiling techniques and cluster analysis to reveal complex immune biology in the tumor microenvironment of mesothelioma
Presenter: Carmen Ballesteros-Merino
Session: Poster Display session 3
Resources:
Abstract
5736 - Predictive factors of response to immunotherapy in 198 patients with metastatic non-microcytic lung cancer (mNSCLC): real world data from 2 university hospitals in Spain
Presenter: Juan Felipe Cordoba Ortega
Session: Poster Display session 3
Resources:
Abstract
5645 - Evaluating Lung CT Density Changes Among Patients with Extensive Stage Small Cell Lung Cancer (ES-SCLC) Treated with Thoracic Radiotherapy (TRT) alone or TRT Followed by Combined Ipilimumab (IPI) and Nivolumab (NIVO).
Presenter: Kujtim Latifi
Session: Poster Display session 3
Resources:
Abstract
1540 - Immuno-oncology therapy biomarkers differences between polyoma-virus positive and negative Merkel cell carcinomas
Presenter: Zoran Gatalica
Session: Poster Display session 3
Resources:
Abstract
4538 - Can we improve patient selection for phase 1 clinical trials (Ph1) based on Immuno-Oncology score prognostic index (VIO)?
Presenter: Ignacio Matos Garcia
Session: Poster Display session 3
Resources:
Abstract