experience but is unlikely to significantly impact on early diagnosis or long term survival Vague symptom patients typically represent an elderly population with comorbidity. This is reflected in the fact that 21% of benign cases subsequently died within 3 months of initial referral and most commonly associated with chronic chest comorbidity and sepsis. In the majority of cases, no specific diagnosis was apparent, however, a number of common themes did emerge concerning rheumatological disease and general comorbidity. The option of direct to CT evaluation offers an alternative strategy to improve early detection. In this cohort, CT request typically followed a more localising specific symptom/sign and the 37 new cancers were detected (25%), suggesting that the threshold to request imaging may be set too high. CT identification of suspected malignancy delivered a median time to treatment of 34 days (0-150 days) although a number of patients still had lengthy diagnostic pathways. Next Steps Agreement has been reached to continue the vague symptom pathway and analysis for a further 12 months to underpin MDC development The evaluation of direct CT will continue as part of a multi-hospital initiative. The On-going coordinator role and data management support is viewed as an aspect of a more comprehensive AO business case to support multiple work streams aimed at promoting admission avoidance in emergency cancer care. The Pilot work have created a Merseyside forum for collaborative working between the Cancer Centre (AO), secondary care, Primary Care and CCGs. An MDC concept emerging from the pilot requires 3 components: Timely access to advice and signposting to referral pathway Agreed set of Symptom directed Triage tests (in community, organised by Primary Care) Facilitated referral, access to complex diagnostics and coordination into a virtual clinic (incorporating all services) APPENDIX 1
experience but is unlikely to significantly impact on early diagnosis or long term survival Vague symptom patients typically represent an elderly population with comorbidity. This is reflected in the fact that 21% of benign cases subsequently died within 3 months of initial referral and most commonly associated with chronic chest comorbidity and sepsis. In the majority of cases, no specific diagnosis was apparent, however, a number of common themes did emerge concerning rheumatological disease and general comorbidity. The option of direct to CT evaluation offers an alternative strategy to improve early detection. In this cohort, CT request typically followed a more localising specific symptom/sign and the 37 new cancers were detected (25%), suggesting that the threshold to request imaging may be set too high. CT identification of suspected malignancy delivered a median time to treatment of 34 days (0-150 days) although a number of patients still had lengthy diagnostic pathways. Next Steps Agreement has been reached to continue the vague symptom pathway and analysis for a further 12 months to underpin MDC development The evaluation of direct CT will continue as part of a multi-hospital initiative. The On-going coordinator role and data management support is viewed as an aspect of a more comprehensive AO business case to support multiple work streams aimed at promoting admission avoidance in emergency cancer care. The Pilot work have created a Merseyside forum for collaborative working between the Cancer Centre (AO), secondary care, Primary Care and CCGs. An MDC concept emerging from the pilot requires 3 components: Timely access to advice and signposting to referral pathway Agreed set of Symptom directed Triage tests (in community, organised by Primary Care) Facilitated referral, access to complex diagnostics and coordination into a virtual clinic (incorporating all services) APPENDIX 1
St%20Helens%20&%20Knowsley%20NHS%20Trust%20%20ACE%20Pilot%20Final%20Report.docx