To what extent can Multidisciplinary Diagnostic Centres respond to the referral requirements of patients with non-specific but concerning symptoms?

Problem

Patients presenting with non-specific but concerning symptoms (NSCS) often do not fit referral criteria for specific tumour pathways. Consequently ‘Accelerate, Coordinate, Evaluate’ (ACE) projects piloted Multi-disciplinary Diagnostic Centres (MDCs) to address the needs of these patients. Their remit was to assess the potential to achieve earlier diagnosis of cancers or other diseases for complex patients with NSCS.

To build a more comprehensive picture of the diagnostic needs of these patients, primary care information was obtained from the National Cancer Diagnosis Audit (NCDA). This overview will present findings of the NCDA analysis and the overall evaluation from the MDC pilots.

Approach

1/NCDA data for cancers diagnosed in England in 2014 were linked with additional National Cancer Registration and Analysis Service datasets. Patients with NSCS were identified using the referral criteria developed by the MDCs. A NSCS (only included NSCS) and a non-NSCS cohort were created.

2/A dataset was agreed across the MDC programme and focused on demographic, diagnostic process of cancers and incidental diseases. Ten pilot sites were in Airedale, Greater Manchester, Leeds, London and Oxford. Analysis was based on MDC referrals up to 31st July 2018.

Findings

1/ There were 2,865 records in the NSCS cohort vs 10,333 in the non-NSCS cohort. Compared to non-NSCS patients, NSCS patients had additional consultations in primary care before referral with 13% having 5 or more vs 7%. They had more primary care ordered investigations including blood tests and imaging. They experienced higher percentage of emergency presentations (34% vs 16%) and less early stage cancers 33% vs 55%.

The median interval times in days were 11 vs 2 for primary care interval, 47 vs 38 for diagnosis interval and 28 vs 24 for referral to diagnosis.

2/Across the MDCs, 2,961 patients presented with comorbidities from mild (43%) to moderate and severe (27%). The main symptoms were weight loss (63%), abdominal pain (30%) and nausea and loss of appetite (28%). 35% of cases mentioned GP gut feeling as a reason for referral.

239 cancers were recorded giving an 8% conversion rate at programme level. The main tumour types were upper-GI tract and Lung (22% each). 27% of tumours presented at early stage. The median interval time for GP referral to cancer diagnosis was 19 days. A third of the referrals resulted in non-cancer diagnoses.

Consequences

The NCDA analysis helps us to understand that patients with NSCS are more likely to experience longer pathways with more primary care investigations and consultations before referral than those with more obvious symptoms.

Results from the MDC evaluation highlight their usefulness in providing a rapid diagnostic pathway for patients with non-specific but concerning symptoms that is well configured to diagnose hard to detect cancers.