First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer

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Abstract

Background

Patients with non-specific symptoms often experience longer times to diagnosis and poorer clinical outcomes than those with site-specific symptoms. This paper reports initial results from five multidisciplinary diagnostic centre (MDC) projects in England, piloting rapid referral for patients with non-specific symptoms.

Methods

The evaluation covered MDC activity from 1st December 2016 to 31st July 2018, with projects using a common dataset. Logistical regression analyses were conducted, with a diagnosis of any cancer as the dependent variable. Exploratory analysis was conducted on presenting symptoms and diagnoses of cancer, and on comparisons within these groupings.

Results

In total, 2961 patients were referred into the MDCs and 241 cancers were diagnosed. The pathway detected cancers across a broad range of tumour sites, including several rare and less common cancers. An association between patient age and cancer was identified ( p < 0.001). GP ‘clinical suspicion’ was identified as a strong predictor of cancer ( p = 0.006), with a reduced association with cancer observed in patients with higher numbers of GP consultation before referral ( p = 0.008).

Conclusions

The MDC model diagnoses cancer in patients with non-specific symptoms, with a conversion rate of 8%, demonstrating the diagnostic potential of a non-site-specific symptomatic referral pathway.

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Most cited references 15

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Symptom Signatures and Diagnostic Timeliness in Cancer Patients: A Review of Current Evidence

Minjoung M. Koo, William Hamilton, Fiona Walter … (2017)

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 help the targeting of early diagnosis initiatives is an area of emerging research. In this Review, we consider the methodological challenges in studying the presenting symptoms and intervals to diagnosis of cancer patients, and summarize current evidence on presenting symptoms associated with a range of common and rarer cancer sites. We propose a taxonomy of cancer sites considering their symptom signature and the predictive value of common presenting symptoms. Finally, we consider evidence on associations between symptomatic presentations and intervals to diagnosis before discussing implications for the design, implementation, and evaluation of public health or health system interventions to achieve the earlier detection of cancer.

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Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study

Minjoung Koo, Ruth Swann, Sean McPhail … (2020)

Summary Background Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis. Methods In this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I–III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms. Findings We analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1–3; eight of 584 patients) for abnormal mole to 80% (71–87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the “any other symptom” category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV. Interpretation Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease. Funding UK Department of Health's Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis; and Cancer Research UK.

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The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

Mads Lind Ingeman, Morten Bondo Christensen, Flemming Bro … (2015)

Background A Danish cancer pathway has been implemented for patients with serious non-specific symptoms and signs of cancer (NSSC-CPP). The initiative is one of several to improve the long diagnostic interval and the poor survival of Danish cancer patients. However, little is known about the patients investigated under this pathway. We aim to describe the characteristics of patients referred from general practice to the NSSC-CPP and to estimate the cancer probability and distribution in this population. Methods A cross-sectional study was performed, including all patients referred to the NSSC-CPP at the hospitals in Aarhus or Silkeborg in the Central Denmark Region between March 2012 and March 2013. Data were based on a questionnaire completed by the patient’s general practitioner (GP) combined with nationwide registers. Cancer probability was the percentage of new cancers per investigated patient. Associations between patient characteristics and cancer diagnosis were estimated with prevalence rate ratios (PRRs) from a generalised linear model. Results The mean age of all 1278 included patients was 65.9 years, and 47.5 % were men. In total, 16.2 % of all patients had a cancer diagnosis after six months; the most common types were lung cancer (17.9 %), colorectal cancer (12.6 %), hematopoietic tissue cancer (10.1 %) and pancreatic cancer (9.2 %). All patients in combination had more than 80 different symptoms and 51 different clinical findings at referral. Most symptoms were non-specific and vague; weight loss and fatigue were present in more than half of all cases. The three most common clinical findings were ‘affected general condition’ (35.8 %), ‘GP’s gut feeling’ (22.5 %) and ‘findings from the abdomen’ (13.0 %). A strong association was found between GP-estimated cancer risk at referral and probability of cancer. Conclusions In total, 16.2 % of the patients referred through the NSSC-CPP had cancer. They constituted a heterogeneous group with many different symptoms and clinical findings. The GP’s gut feeling was a common reason for referral which proved to be a strong predictor of cancer. The GP’s overall estimation of the patient’s risk of cancer at referral was associated with the probability of finding cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1424-5) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

D. Chapman:

ORCID: http://orcid.org/0000-0002-7570-4462

dave.chapman@cancer.org.uk

Journal

Journal ID (nlm-ta): Br J Cancer

Journal ID (iso-abbrev): Br. J. Cancer

Title: British Journal of Cancer

Publisher: Nature Publishing Group UK (London )

ISSN (Print): 0007-0920

ISSN (Electronic): 1532-1827

Publication date (Electronic): 6 July 2020

Publication date PMC-release: 6 July 2020

Publication date (Print): 1 September 2020

Volume: 123

Issue: 5

Pages: 722-729

Affiliations

[1 ]GRID grid.11485.39, ISNI 0000 0004 0422 0975, Cancer Research UK, ; London, UK

[2 ]GRID grid.4868.2, ISNI 0000 0001 2171 1133, Centre for Cancer Prevention, , Wolfson Institute of Preventative Medicine, Queen Mary University of London, ; London, UK

[3 ]GRID grid.1006.7, ISNI 0000 0001 0462 7212, Institute of Population Health Sciences, Newcastle University, ; Newcastle upon Tyne, UK

[4 ]GRID grid.8391.3, ISNI 0000 0004 1936 8024, University of Exeter Medical School (Primary Care), ; Devon, UK

Author information

D. Chapman http://orcid.org/0000-0002-7570-4462

V. Poirier http://orcid.org/0000-0002-7289-2250

D. Vulkan http://orcid.org/0000-0003-4738-9378

K. Fitzgerald http://orcid.org/0000-0002-8700-5562

G. Rubin http://orcid.org/0000-0002-4967-0297

W. Hamilton http://orcid.org/0000-0003-1611-1373

S. W. Duffy http://orcid.org/0000-0003-4901-7922

Article

Publisher ID: 947

DOI: 10.1038/s41416-020-0947-y

PMC ID: 7462853

PubMed ID: 32624574

SO-VID: 0cd9d404-bcb6-45fa-a1e0-957a4fce908d

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 1 August 2019

Date revision received : 19 May 2020

Date accepted : 4 June 2020

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer,health services

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cancer, health services

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First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer

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Most cited references 15

Symptom Signatures and Diagnostic Timeliness in Cancer Patients: A Review of Current Evidence

Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study

The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

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