Centre for fast cancer diagnosis in Wales reduced waiting times ‘by 92%’

A centre for fast cancer diagnosis piloted in Wales reduced waiting times for patients by up to 92% in its first year and has become cheaper than current practice, analysis has found.

Patients going to GPs with non-specific, potentially cancerous symptoms were sent to a rapid diagnosis centre at Neath Port Talbot Hospital (NPTH) where they were diagnosed significantly faster.

The Swansea Bay University Health Board (SBUHB) pilot saw waiting times slashed to less than six days for people with suspected cancer, another condition, or no serious pathology.

Between June 2017 and May 2018, 189 adults were referred by their GP, an average 2.78 patients per half-day clinic running twice a week.

Patients were either diagnosed with suspected cancer and referred to a specialist, given a non-cancer diagnosis, told no serious pathology could be found, or sent for further investigations.

Those with suspected cancer (23 patients), another condition (30 patients) or no serious pathology (68 patients) were diagnosed in an average of 5.9 days.

Those who required further investigation (68 patients) received diagnosis within an average of 40.8 days.

In comparison, control patients waited an average of 84.2 days – just under three months.

When cancer is diagnosed at a late stage survival is less likely, treatment is more costly and quality of life can be diminished. Long waits can also be anxious for patients.

The Government has set a target that 75% of all cancers should be diagnosed at an early stage by 2028.

However, some cancers are hard to detect early on because the symptoms are not specific.

For example, people with ovarian cancer may have broad symptoms that could indicate other conditions, including loss of appetite, needing to urinate frequently and stomach pain.

Currently, GPs refer people who present with red flags to an urgent suspected cancer pathway.

However, 50% of UK cancer patients do not present with these alarm symptoms and their diagnosis takes an average of 34 days longer.

These patients, who may suffer with vague symptoms such as unexplained weight loss, fatigue, abdominal or generalised pain, will be sent for outpatient appointments and diagnostic tests, which can take a long time and be expensive.

During the study period, 23 cancers were diagnosed, with lung, renal and pancreatic cancer, as well as lymphoma and malignancy of unknown origin, (MOU) the most common.

Thirty significant non-cancer diagnoses were made, including stomach ulcers, gastritis, heart failure, pulmonary emboli, blood clots, abscesses and tuberculosis.

During the first year the centre was running, it did not see enough patients to be cost effective when compared with current practice, the authors said.

Since July 2018, the centre has run near or at full capacity, consistently seeing between four and five patients per clinic over the last year, and is now outperforming usual care.

The authors write: “Referral to rapid diagnosis services from primary care for patients with vague and/or non-specific symptoms suspicious of cancer addresses an important unmet need and provides value for money when run near or at full capacity.

“Furthermore, it reduces time to diagnosis and has the potential to improve patient outcomes.”

They believe their analysis is a conservative indication of the benefits the centre could bring.

They add: “These immature data did not allow extrapolation of the longer-term impact of the RDC on healthcare resource use, patient outcomes, or survival.

“Considering the potential positive effect of earlier diagnosis on prognosis, this omission will underestimate the cost-effectiveness of the RDC.

“It is therefore planned to extend the model to a longer-term time horizon as soon as more mature data become available.”

The team initially feared the initial additional resources and costs associated with the centre may displace other services for cancer patients if rolled out more widely.

However, their analysis suggests the concept saves money overall, and bringing in more centres would benefit patients, GPs and the NHS.

The evaluation, funded by Cancer Research UK (CRUK), is published in the British Journal of General Practice (BJGP).

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