Expert Advisory Groups

A proportion of patients who present in clinical practice who end up with a cancer diagnosis initially present with non-specific symptoms, and previously there was no dedicated urgent diagnostic pathway for this cohort of patients. Most pre-existing urgent suspected cancer pathways focussed on the suspicion of tumour-specific disease rather than diagnosing symptoms. From 2019 the National Health Service implemented a vision to create Rapid Diagnostic Centres to develop services for cohorts of patients with non-specific symptoms offering coordinated testing, timely diagnosis and, where appropriate, appropriate onward referral.

Non-Specific Symptoms (as defined by NG 12) include unexplained:

• weight loss,
• fatigue,
• abdominal pain or nausea, or
• a GP ‘gut feeling’ about cancer.

Patients with non-specific symptoms historically would often see their GP multiple times before referral, were sometimes referral on multiple Urgent Suspected Cancer pathways with resulting inefficiencies, sometime ended up presenting in an emergency setting, and were often eventually diagnosed with late-stage cancer. This together with the fact that up to 50% of patients with cancer in UK general practice do not present with the red flags required for referral to a site-specific suspected cancer pathway, has led to a clear call for alternative pathways to be implemented.

The implementation of NSS pathways build on the success of other international leaders such as the Danish three-legged strategy which allowed patients with serious non-specific symptoms to first undergo fast-tracked diagnostic tests with their GP, followed by a referral to a hospital-based diagnostic centre if the tests are inconclusive. In the UK a model of Multidisciplinary Diagnostic Centres was set up as part of the Accelerate Coordinate Evaluate (ACE) programme, which proved successful and led to more widespread adoption of NSS pathways. The ACE evaluation proved that around 8% of patients presented with Non-Specific Symptoms are likely to be diagnosed with some form of cancer, and over a third receive a timely diagnosis of a non-cancer condition.

NSS pathways have been set up around the UK and have evolved over time to include a variety of different models, including the diagnostic workup of malignancy of unknown origin, urgent and emergency care pathway diversion of symptomatic patients, and much more. All Integrated Care Systems across the West Midlands have NSS provision for relevant patients and operate within the Faster Diagnosis Framework.