The effectiveness of the Guy's Rapid Diagnostic Clinic (RDC) in detecting cancer and serious conditions in vague symptom patients

Abstract

Background: Rapid Diagnostic Clinics (RDC) are being expanded nationally by NHS England. Guy's RDC established a pathway for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for a site-specific 2WW referral. However, little data assessing the effectiveness of RDC models are available in an English population.

Methods: We evaluated all patients referred to Guy's RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service.

Results: There were 96 new cancer diagnoses (7.2%): lung (16%), haematological (13%) and colorectal (12%)-with stage IV being most frequent (40%). Median time to definitive cancer diagnosis was 28 days (IQR 15-47) and treatment 56 days (IQR 32-84). In all, 75% were suitable for treatment: surgery (26%), systemic (24%) and radiotherapy (14%). Over 180 serious non-neoplastic conditions were diagnosed (35.8%) of patients with no significant findings in two-third of patients (57.0%).

Conclusions: RDCs provide GPs with a streamlined pathway for patients with complex non-site-specific symptoms that can be challenging for primary care. The 7% rate of cancer diagnosis exceeds many 2WW pathways and a third of patients presented with significant non-cancer diagnoses, which justifies the need for rapid diagnostics. Rapid Diagnostic Centres (RDCs) are being rolled out nationally by NHS England and NHS Improvement as part of the NHS long-term plan. The aim is for a primary care referral pathway that streamlines diagnostics, patient journey, clinical outcomes and patient experience. This pilot study of 1341 patients provides an in-depth analysis of the largest single RDC in England. Cancer was diagnosed in 7% of patients and serious non-cancer conditions in 36%-justifying the RDC approach in vague symptom patients.

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1. Timeline of clinical care runs vertically.

Oversight of clinical responsibility for the patient is shown by the white arrow for primary care and blue arrow for secondary care. Funding is by the clinical commissioning group, cancer alliance and Guy’s hospital in the box. 2WW two week wait criteria, RDC rapid diagnostic clinic, ANP advanced nurse practitioner, ECG electrocardiogram, ECHO echocardiogram, CCG clinical commissioning group.

Fig. 2. Cancers cases (n = 96) by stage and treatment.

a Cancer type on x axis compared to percentage patients by tumour stage on the y axis. Stage I is dark blue, II light blue, III pink, IV purple and grey is not known (NK). b Cancer type on x axis compared to percentage of patients that received primary anti-cancer treatment. Treatments include surgery (dark blue), systemic anti-cancer treatment (light blue), radiotherapy (pink), loco-regional therapies such as ablation (purple), surveillance (dark green), none or best supportive care (BSC, black) and not known (NK, grey).

Fig. 3. Serious benign conditions (n = 480); percentage (%) of patients affected by speciality.

Pie chart highlighting the different specialities patients with non-cancer conditions were referred to which are colour coded with percentage volume of overall referalls. The more common specialities have a breakdown of the types of conditions diagnosed. The percentage in the box is by volume of that speciality. BPH benign prostatic hypertrophy, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, CT connective tissue disorders, ENT ear nose and throat, IBS irritable bowel syndrome, ID infectious diseases, ILD interstitial lung disease, PBC primary biliary cirrhosis, PUJ pelviureteric junction, MGUS monoclonal gammopathy of undetermined significance, SFLC serum free light chain, VTE venous thromboembolic disease.

Fig. 4. Rapid diagnostic clinic diagnostic resource use by a radiological and endoscopy with b median timescales to cancer diagnosis and treatment from RDC review.

a It demonstrates resources used by the clinic. The two-colour pie chart shows the percentage of patients who underwent radiological investigations (blue) arranged by the RDC compared to those where no further tests were done (grey). The dot chart shows the proportion of radiological examinations undertaken. This includes CT (blue), plain radiographs (green), ultrasound (yellow), MRI (grey) and nuclear medicine tests (pink). The three-colour pie chart shows the percentage of patients who had endoscopy (pink), histological samples taken (blue) or none (grey). b The timeline from GP referral to RDC review and median cancer diagnosis and treatments. The grey boxes outlined the median value and the interquartile range (IQR).