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
3628 - Predictive model for survival in advanced non-small-cell lung cancer (NSCLC) treated with frontline pembrolizumab
Presenter: Xabier Mielgo Rubio
Session: Poster Display session 3
Resources:
Abstract
5705 - External validation and longitudinal extension of the LIPI (Lung Immune Prognostic Index) for immunotherapy outcomes in advanced non-small cell lung cancer.
Presenter: Jakob Riedl
Session: Poster Display session 3
Resources:
Abstract
5758 - Changes of TCR Repertoire in Metastatic Renal Cell Carcinoma and Metastatic Melanoma Patients Treated with Nivolumab
Presenter: Martin Klabusay
Session: Poster Display session 3
Resources:
Abstract
1743 - Expression of MHC class I, HLA-A and HLA-B identifies immune activated breast tumors with favorable outcome
Presenter: María Del Mar Noblejas López
Session: Poster Display session 3
Resources:
Abstract
2219 - Prognostic Significance of Tumor Tissue NeuGcGM3 Ganglioside Expression and Predictive Value of Circulating Tumor Cell Count Monitoring in Patients Receiving Racotumomab Immunotherapy
Presenter: Necdet Üskent
Session: Poster Display session 3
Resources:
Abstract
2996 - Evolution of Myeloid-Derived Suppressor Cells and Objective Response Rate in Relapsed/Refractory Diffuse Large B Cell Lymphoma (R/R DLBCL) patients after receiving immunotherapy
Presenter: Carlos Jiménez Cortegana
Session: Poster Display session 3
Resources:
Abstract
2110 - A Phase Ia/Ib trial of the anti-programmed death-ligand 1 (PD-L1) human monoclonal antibody (mAb), CS1001, in patients (pts) with advanced solid tumors or lymphomas
Presenter: Lin Shen
Session: Poster Display session 3
Resources:
Abstract
3515 - Results from a randomised Phase 1/2 trial evaluating the safety and antitumour activity of anti-PD-1 (MEDI0680)/anti-PD-L1 (durvalumab) vs anti-PD-1 (nivolumab) alone in metastatic clear cell renal cell carcinoma (ccRCC)
Presenter: Martin Voss
Session: Poster Display session 3
Resources:
Abstract
3566 - Pembrolizumab in Advanced Rare Cancers
Presenter: Aung Naing
Session: Poster Display session 3
Resources:
Abstract
3567 - High clinical benefit rates of pembrolizumab in very rare sarcoma histotypes: first results of the AcSé Pembrolizumab study
Presenter: Jean-Yves Blay
Session: Poster Display session 3
Resources:
Abstract