Impact of a CUP service at the Royal Derby Hospital - One year on

Abstract

Background: 9600 UK patients are diagnosed with Cancer of Unknown Primary (CUP) each year. CUP represents 3-5% of all malignancies. Studies showthe diagnostic pathway to be lengthy, fractured between specialities, and that patients find it a difficult diagnosis to accept. In 2010 National Institute of Health & Clinical Excellence (NICE) issued guidelines recommending a Multidisciplinary Team (MDT) approach to managing patients with CUP. In 2013 Royal Derby Hospital (RDH), serving 600,000 people, launched a CUP MDT led by a Consultant Oncologist and two Specialist Nurses. Method: Utilising an in-house database of patients referred to CUP MDT, data for May 2014-15 was extracted, analysed and compared with data audited from May 2013-14. Results: 119 patients were referred to CUP MDT in May 2014-15. 74% of patients were seen by a member of CUP MDT. 56 (47.1%) were eventually diagnosed with CUP, 50 (42%) had a primary cancer site identified and 13 (10.9%) did not have cancer. Mean age was 72.2 years with minimal gender variation. Mean survival was 62 days with patients who died before registration, and 71 days without that data set. There were substantial reductions in number of MDT discussions per patient. 13 (10.9%) patients had Positron Emission Tomography (PET) scans. 58 (48.7%) patients solely received best supportive care. Conclusion: Average age, gender, life expectancy, and cancer subtypes reflect national trends. Primary site identification, investigations and treatment show alignment with national guidelines. Reduction in number of MDT discussions is encouraging as it improves patient experience, as do Palliative Medicine and Specialist Nurse input. RDH CUP MDT has demonstrated improvements in speed and accuracy of diagnosis in a well co-ordinated approach to care. A recommendation would be to participate in future gene expression profiling trials, when available, to optimise diagnostic accuracy, treatment options and survival.