The effectiveness of the Guy’s Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients

Published on Jan 5, 2021in British Journal of Cancer7.64
· DOI :10.1038/S41416-020-01207-7
Saoirse Dolly9
Estimated H-index: 9
 (Guy's and St Thomas' NHS Foundation Trust), Geraint Jones1
Estimated H-index: 1
 (Guy's and St Thomas' NHS Foundation Trust)+ 11 AuthorsLuigi Vincenzo De Michele1
Estimated H-index: 1
 (Guy's and St Thomas' NHS Foundation Trust)
Sources
Abstract
BACKGROUND Rapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy's RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population. METHODS We evaluated all patients referred to Guy's RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service. RESULTS There were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)-with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15-47) and treatment 56 days (IQR 32-84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%). CONCLUSIONS RDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%-justifying the RDC approach in vague symptom patients.
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Jan 1, 2020·British Journal of General Practice5.39
#1Bernadette Sewell (Swansea University)H-Index: 10
#2Mari Jones (Swansea University)H-Index: 6
Last. Deborah Fitzsimmons (Swansea University)H-Index: 21
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Background A pilot rapid diagnosis centre (RDC) allows GPs within targeted clusters to refer adults with vague and/or non-specific symptoms suspicious of cancer, who do not meet criteria for referral under an urgent suspected cancer (USC) pathway, to a multidisciplinary RDC clinic where they are seen within 1 week. Aim To explore the cost-effectiveness of the RDC compared with standard clinical practice. Design and setting Cost-effectiveness modelling using routine data from Neath Port Talbot Ho...
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Sep 23, 2019·BMJ2.30
#1Brian D Nicholson (University of Oxford)H-Index: 17
#2Paul Aveyard (University of Oxford)H-Index: 67
Last. FD Richard Hobbs (University of Oxford)H-Index: 56
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Jul 9, 2019·BMJ Open2.69
#1Anette Fischer Pedersen (AU: Aarhus University)H-Index: 21
#2Christina Maar Andersen (University of Southern Denmark)H-Index: 7
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May 1, 2019·Annals of The Royal College of Surgeons of England1.89
#1J ChristopherH-Index: 1
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Introduction The 2015 National Institute for Health and Care Excellence guidelines widened the referral criteria for the two-week-wait pathway for suspected lower gastrointestinal cancer. We implem...
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Jan 1, 2019·European Journal of Cancer Care2.52
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#2Lindsay Forbes ('KCL': King's College London)H-Index: 23
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Abstract Early diagnosis is an important aspect of contemporary cancer prevention and control strategies, as the majority of patients are diagnosed following symptomatic presentation. The nature of presenting symptoms can critically influence the length of the diagnostic intervals from symptom onset to presentation (the patient interval), and from first presentation to specialist referral (the primary care interval). Understanding which symptoms are associated with longer diagnostic intervals to...
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Oct 28, 2021·British Journal of General Practice5.39
#1Simon Erridge (UCL: University College London)
#2Georgios Lyratzopoulos (UCL: University College London)H-Index: 51
Last. Richard W J Lee (The Royal Marsden NHS Foundation Trust)H-Index: 30
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Early cancer diagnosis is a clinical and research priority of the UK government. Earlier cancer diagnosis should enable identification of cancers at an earlier stage, leading to improved outcomes.1 This must be balanced with the potential physical and psychological harms of over-investigation and over-diagnosis. The ‘two-week wait’ (2WW) referral pathway represents the most common route to cancer diagnosis. However, only 39% of cancer diagnoses were made via 2WW pathways in 2017, while significa...
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Sep 6, 2021·British Journal of Cancer7.64
#1Mark Stares (Edin.: University of Edinburgh)
#2Karin Purshouse (Edin.: University of Edinburgh)H-Index: 9
Last. Marjory MacLennan (Western General Hospital)
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Aug 26, 2021·British Journal of General Practice5.39
#1Richard D Neal (University of Exeter)H-Index: 1
#2Lesley Smith (University of Leeds)H-Index: 7
Urgent GP cancer referrals, often referred to as 2-week wait (2WW) referrals in England (with equivalent processes in the devolved nations), have changed the landscape of cancer diagnosis in the UK. The data presented by Round et al ,1 demonstrate this starkly: referrals have increased hugely over the past decade and the detection rate (DR; the percentage of new cancer cases treated resulting from a 2WW referral) has increased from 41% to 52% over this period. This is especially good news as pat...
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