First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer
Dave Chapman, V. Poirier, Daniel Vulkan, Karen Fitzgerald, Greg Rubin, William Hamilton, Stephen W. Duffy, on behalf of the ACE MDC projects, Airedale MDC pilot, Alan Hart Thomas, Dawn Gulliford, Helena Rolfe, Greater Manchester MDC pilots, M. Hohmann, Chris Repperday, Susan Sykes, S. F. Rebecca Taylor, Leeds MDC pilot, Angie Craig, James A. Dawson, Sarah Forbes, Helen Ryan, Rob Turner, London MDC pilots, Mush Ahmad, Donna Chung, David I. Graham, Andrew Millar, Sara Taiyari, Oxford MDC pilot, Claire Friedemann Smith, Fergus Gleeson, Shelley Hayles, Zoe Kaveney, Brian D Nicholson
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.