Cancers of unknown primary diagnosed during hospitalization: a population-based study

Abstract

BackgroundCancers of Unknown Primary (CUP) are the 3-4th most common causes of cancer death and recent clinical guidelines recommend that patients should be directed to a team dedicated to their care. Our aim was to inform the care of patients diagnosed with CUP during hospital admission.MethodsDescriptive study using hospital admissions (Scottish Morbidity Record 01) linked to cancer registrations (ICD-10 C77-80) and death records from 1998 to 2011 in West of Scotland, UK (population 2.4 m). Cox proportional hazards models were used to assess effects of baseline variables on survival.ResultsSeven thousand five hundred ninety nine patients were diagnosed with CUP over the study period, 54.4% female, 67.4% aged ≥ 70 years, 36.7% from the most deprived socio-economic quintile. 71% of all diagnoses were made during a hospital admission, among which 88.6% were emergency presentations and the majority (56.3%) were admitted to general medicine. Median length of stay was 15 days and median survival after admission 33 days. Non-specific morphology, emergency admission, age over 60 years, male sex and admission to geriatric medicine were all associated with poorer survival in adjusted analysis.ConclusionsPatients with a diagnosis of CUP are usually diagnosed during unplanned hospital admissions and have very poor survival. To ensure that patients with CUP are quickly identified and directed to optimal care, increased surveillance and rapid referral pathways will be required.

Molecular Profiles of Brain and Pulmonary Metastatic Disease in Cancer of Unknown Primary

“…Cancers of unknown primary present a challenge to diagnosis and treat. Older patients are more likely to have a CUP, with median age 65-90 years [1][2][3]. The majority of CUPs are adenocarcinoma, although squamous, as in our patient, high-grade neuroendocrine and poorly differentiated carcinomas all exist as histopathologic CUP subtypes [2][3][4].…”

Integration of a patient-centred MUO/CUP service within a new acute oncology service: challenges and rewards

“…Contemporary studies have published dismal survival rates in CUP patients, although our data (Fig 1b) and published reports demonstrate that favourable sub-groups can do significantly better. 4,11,12 The majority in the retrospective group and 100% of patients in the prospective group were offered palliative care (16.67% did not need it or refused in the prospective group). Yet, we note that hospice placements in both groups were overall quite low as compared with reports published by English peers; this may be reflective of some uniqueness in cultural differences and social values specific to Northern Ireland that can influence patient choice and carer support.…”

“…Notwithstanding these limitations, as compared with median LOS of 15 days in a descriptive study done on a historical cohort of 7,599 MUO/CUP patients, in our prospective group, median LOS of 7.75 days was considerably lower. 12 As such, we feel that defining performance indicators for MUO/CUP patients should go beyond conventional markers such as LOS, readmission rates, survival outcomes and place of death. Additional parameters such as quantifying MDM discussions, invasive/non-invasive investigations, as well as timeframe from diagnosis to referral, from referral to DTT and from DTT to definitive management in the pathway perhaps can be explored.…”

Diagnostic and health service pathways to diagnosis of cancer-registry notified cancer of unknown primary site (CUP)

“…Cancer of unknown primary site (CUP) is the 14 th most commonly diagnosed cancer and the 6 th most common cause of cancer death in Australia. [1] It is characterized by metastatic disease with an unidentified primary site, and extremely poor survival; [2][3][4][5] in Australia, the 5-year survival rate is 13%. [6] Population-based CUP incidence rates have declined over time, [2,6,7] a trend that can most likely be attributed to advances in diagnostic investigations.…”

“…While a diagnosis of CUP ideally should be limited to people with a histological confirmation of metastatic cancer, in whom thorough testing has failed to identify the site of the primary tumor, people registered with a diagnosis of CUP in population-based cancer registries are heterogeneous, with many people receiving a diagnosis based on clinical examination only. [4,5,[8][9][10][11] Thus, it is difficult to compare population-based studies of registry-notified CUP to cases series of "true CUP" cases, who have received exhaustive investigations.…”