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Cancer services: new vague symptoms pathway introduced
Our cancer services team have recently introduced a new vague symptoms pathway that provides an assessment and diagnostics for patients with the following:
z Non-specific symptoms that could indicate cancer who do not fit other two week wait criteria for a cancer referral, but there is a significant risk of an underlying malignancy
The pilot pathway has been designed to ensure that our patients are referred to an appropriate pathway and a diagnosis is pursued, whether it is cancer or otherwise.
GPs are able to refer patients on the vague symptom pathway referral based on the following criteria:
z New unexplained weight loss z New unexplained constitutional symptoms of four weeks or more z New unexplained vague abdominal pain of four weeks or more z New unexplained, unexpected or progressive pain, including bone pain, of four weeks or more z GP ‘gut feeling’ of cancer diagnosis – reasons to be clearly described at referral z New and unexplained breathlessness for more than three weeks not due to heart failure, venous
thromoboembolism (VTE), ischemic heart disease (IHD), COPD or chest infection z Unexplained thromboembolism z Abnormal laboratory findings not explained by established or self-limiting disease and not needing admission
Important note
Patients must be fit and suitable for investigation and not fit the criteria for any other urgent referral pathway.
There are mandatory tests that should be carried out and reviewed in primary care before referring a patient to this pathway. This will rule out a more common diagnosis that would be better managed directly through the appropriate specialty multi-disciplinary team.
The tests are available on ICE as a bundle under vague symptoms pathway tests, and a chest X-ray must be requested separately.
The following mandatory investigations must be completed prior to referral – the referral will be returned to the GP if the tests have not been completed:
z FBC z ESR AND CRP z B12, folate and ferritin z FIT z MSU z HIV z GGT z U&Es, TFTs, LFTs z PSA/CA125 z HbA1c z CXR z Bone profile z Clotting screen z LDH
There may be other diagnostics that are required after initial review of the patient – the responsible person who delivers the diagnostics would be asked to support a quick turnaround, ideally within 48 hours of the request.
If you have any questions or would like any further information, please contact Dr Robert Ghosh, associate medical director and clinical lead for the referral pathway, email: robertghosh@nhs.net or Bernadette Roach, head of cancer services at bernadette. roach@nhs.net.
