What are the new 'one-stop shops' for less obvious cancer symptoms, and how is this service being developed and evaluated in Oxfordshire? GP and Clinical Researcher Dr Brian D Nicholson, from the Nuffield Department of Primary Care Health Sciences, is part of the team who developed the region’s pilot site, one of ten across the country, and explains why understanding non-specific symptoms is important.
Last week the New Scientist reported 'around half of people with cancer have vague or non-specific symptoms, such as loss of appetite or weight. As a result, they can end up being referred to several specialists before receiving a diagnosis.'
The Telegraph added 'new "one-stop shops" to speed up cancer diagnosis are being trialled across the country for the first time. GPs can refer patients suffering from "vague" symptoms… to undergo multiple tests for different cancers.'
Cancer Research UK’s director of early diagnosis, Sara Hiom, was quoted: 'We’re confident that these ten pilot centres will give us a much better understanding of what’s needed to speed up the diagnosis and treatment of people with less obvious symptoms, improve their experience of care and, ultimately, survival.'
The public response was mixed, ranging from outrage over another postcode lottery of NHS resource allocation, to reminders about the initiative’s nature as a pilot which is subject to evaluation before being rolled out nationally.
I’m part of a team of GPs and health researchers at the University of Oxford’s Nuffield Department of Primary Care Health Sciences (NDPCHS) who conduct research into non-specific cancer symptoms and developed the “one-stop shop” pilot site for Oxfordshire. Known as the Suspected CANcer (SCAN) pathway, we’ve developed this in close collaboration with clinicians, researchers, commissioners, and heath care professionals from the Oxfordshire Clinical Commissioning Group and Oxford University Hospitals NHS Foundation Trust (OUH).
Our site is one of ten diagnostic centre pilot sites set-up by local health care teams as part of the Accelerate Coordinate Evaluate (ACE) programme, funded by NHS England, Cancer Research UK and Macmillan.
Why non-specific symptoms?
Specific cancer symptoms point to cancer of a specific body location. For example, coughing up blood can be linked with lung cancer, while difficulty swallowing can be linked with cancer of the food pipe (the oesophagus). Specific symptoms give a clear signal to GPs about where in the body to perform tests for cancer, and the NHS provides GPs with rapid access to tests.
Non-specific cancer symptoms can be more challenging for GPs and include tiredness, loss of appetite, tummy pain, feeling generally unwell and weight loss. They are more common and are linked with several non-cancer (benign), long-term and short-term conditions seen by many GPs. What is more challenging is that non-specific symptoms can also be linked with cancer of more than one part of the body, making it more difficult for GPs to choose the most appropriate investigation to perform first.
The NHS, until now, has not been set-up to provide GPs with access to rapid tests to urgently investigate these non-specific symptoms across different parts of the body.
Weight loss, for example, is linked with ten different types of cancer and is the second most common symptom of colorectal, lung, pancreatic and kidney cancer. Our latest research on weight-loss shows that in the over 60s, the risk of cancer in patients presenting with weight loss is higher than previously thought (BJGP Link), so systems that fast-track investigations of unexplained weight loss to either diagnose or rule-out cancer earlier are urgently needed.
Ten centres, ten different approaches
The newly-launched cancer diagnostic initiative has been developed to evaluate what sort of 'one-stop shop' could be effective at diagnosing cancer in the NHS, building on similar clinics used in Denmark. This has taken a lot of time and careful organisation as each of the ten pilot sites have developed a unique “one-stop shop” approach that can be provided in their local areas. To learn the most about what makes an effective “one-stop shop”, the pilot sites were chosen in urban and rural locations, richer and poorer areas, they use different combinations of health professionals and local services, accept a range of non-specific symptoms, and use a variety of different tests.
Oxford’s one-stop-shop for cancer diagnosis
Our local pilot, SCAN, allows all GPs in Oxfordshire to refer patients aged 40 years or over if there is no other urgent referral pathway available, and if they are concerned about cancer or serious disease following a face-to-face consultation for a range of non-specific symptoms. These include: unexplained weight loss, severe unexplained fatigue, persistent nausea or appetite loss, new atypical pain, or unexplained results from a laboratory test. GPs may also refer if they have clinical suspicion of cancer or serious disease, or a 'gut feeling’ that their patient warrants investigation.
All patients referred to SCAN undergo a broad panel of laboratory blood and faecal tests and low-dose Computed Tomography (CT) imaging of the chest abdomen and pelvis. Depending on the results, they may then be referred to the SCAN clinic, where clinicians with expertise in evaluating non-specific symptoms evaluate them in more depth – they’ll be guided through the process by a specialist radiographer, known as the SCAN navigator. Depending on the results of the initial tests, the patient may otherwise get a rapid referral to another cancer pathway, or for a different serious disease.
Evaluating effectiveness, first and foremost
Importantly this initiative is collecting data, with patients’ consent, to evaluate each “one-stop shop” comprehensively. As more patients referred to these pilot sites grows and we collect more data, we will be able to determine what an effective service for patients with non-specific symptoms could look like in the NHS. Once the model has been refined, these one-stop shops will be expanded and made available right across the NHS so that all patients have the opportunity to access rapid investigation via their GP to speed up the diagnosis and treatment of their non-specific symptoms .