Implementation of a metastatic malignancy of unknown primary origin service led by a palliative physician

Abstract

This study suggests having a metastatic malignancy of unknown primary origin service led by a palliative physician does not reduce the number referred for tumour directed therapy. It also adds evidence of the poor prognosis and thus the need for early palliative care input.

Cancer of Unknown Primary: A Review on Clinical Guidelines in the Development and Targeted Management of Patients with the Unknown Primary Site

“…The United State National Cancer Institute (NCI), the National Comprehensive Cancer Network (NCCN), and the European Society of Medical Oncology (ESMO) have published international clinical guidelines on the diagnostic investigations to perform in suspected patients with CUP in order to rule out any cancer presenting with metastasis [2]. In 2010, the National Institute of Clinical Excellence (NICE) endorsed to form a devoted multidisciplinary team of oncologist, palliative physicians, and nurse specialists for the CUP patients [1,15]. The purpose was the early diagnosis and management of the symptoms, later there was no change observed towards the improvement in the performance status or survival time in patients with CUP [15].…”

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

“…The results are in contrast to reports published by other groups using a similar analytic model, where hospital deaths were fewer and home deaths more with an established MUO/CUP service. 10,13 Our results may well be indicative of local variations in availability/ accessibility to hospice placements and social packages during the study periods. Additionally, in the prospective group, more patients underwent comprehensive work-up including invasive investigations and active anti-cancer treatment, which may have inadvertently resulted in more hospital deaths.…”

“…Interestingly, a comprehensive palliative team-led MUO/CUP service, despite demonstrating value in terms of early PCT input (which is a key component of care in this group), failed to show any survival advantage, albeit having limitations of modest sample size and single-site study. 10 In our study, variation in clinical outcomes between the two groups undoubtedly is reflective of a new AOS (with a dedicated AOS CNS) providing early specialist access embedding comprehensively within existing infrastructure of the trust over time. Because CUP service went live more or less in parallel with overarching AOS, as such, it is difficult to tease out the specific survivalrelated benefit from CUP team intervention in isolation.…”

“…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. 10 As compared with the retrospective group, in the prospective group, hospice placements were lower, more patients died in hospital and fewer patients died at home. The results are in contrast to reports published by other groups using a similar analytic model, where hospital deaths were fewer and home deaths more with an established MUO/CUP service.…”

“…Our data on proportion of MUO/CUP AOS referrals, patientprofile and tumour profile is comparable with published reports. 10,11,13 Our study is unique in that it projects conception of the first oncology-led MUO/CUP service as an offshoot of a newly setup AOS in a single cancer centre in Northern Ireland and its positive impact on overall patient journey and outcomes. Apart from NICE published recommendations on CUP-specific waiting times, there are no robust MUO/CUP-specific national guidelines on performance indicators.…”