The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

Abstract

IntroductionCancer survival in England lags behind most European countries, due partly to lower rates of early stage diagnosis. We report the protocol for the evaluation of a multidisciplinary diagnostic centre-based pathway for the investigation of ‘low-risk but not no-risk’ cancer symptoms called the Suspected CANcer (SCAN) pathway. SCAN is a new standard of care being implemented in Oxfordshire; one of a number of pathways implemented during the second wave of the Accelerate, Coordinate, Evaluate (ACE) programme, an initiative which aims to improve England’s cancer survival rates through establishing effective routes to early diagnosis.Methods and analysisTo evaluate SCAN, we are collating a prospective database of patients referred onto the pathway by their general practitioner (GP). Patients aged over 40 years, with non-specific symptoms such as weight loss or fatigue, who do not meet urgent cancer referral criteria or for whom symptom causation remains unclear after investigation via other existing pathways, can be referred to SCAN. SCAN provides rapid CT scanning, laboratory testing and clinic review within 2 weeks. We will follow all patients in the primary and secondary care record for at least 2 years. The data will be used to understand the diagnostic yield of the SCAN pathway in the short term (28 days) and the long term (2 years). Routinely collected primary and secondary care data from patients not referred to SCAN but with similar symptoms will also be used to evaluate SCAN. We will map the routes to diagnosis for patients referred to SCAN to assess cost-effectiveness. Acceptability will be evaluated using patient and GP surveys.Ethics and disseminationThe Oxford Joint Research Office Study Classification Group has judged this to be a service evaluation and so outside of research governance. The results of this project will be disseminated by peer-reviewed publication and presentation at conferences.

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study

“…Although evaluations of rapid and multidisciplinary diagnosis centres are currently underway, 19 this is the first robust and complete analysis of the costeffectiveness of the RDC as part of routine care in the UK. Also, to the best of the authors' knowledge, no economic evaluations of the Danish cancer patient pathway for patients presenting with non-specific symptoms and signs of cancer (NSSC-CPP), on which the UK model of this service is based, exist.…”

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

“…3,99,100 Improving the pathway to diagnosis for patients with non-specific symptoms may be achieved by national programmes in the UK, such as Accelerate Coordinate and Evaluate (ACE) and the Danish 'three-legged strategy', which are investigating the role of multidisciplinary diagnostic centre-based pathways for patients with non-specific symptoms of cancer that fall outside current urgent referral pathways. [101][102][103] Funding Claire Friedemann Smith is funded by a grant from Cancer Research UK (award reference C59898/A23253).…”

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

“…In Denmark, the first diagnostic center (DC) aimed at inter-disciplinary and intersectorial patient pathways was initiated in 2009 followed by further national implementation in 2012 [20,21]. In the UK, a new Suspected CANcer (SCAN) pathway for patients with 'low-risk but not no-risk' is currently being evaluated [22]. Early positive reports from Denmark led us in 2011 to begin developing a model for the first DC in Sweden.…”