Direct GP referrals to the CUP team

A paper by A. Creak – Prospective Cohort of Referrals to a Cancer of Unknown Primary Clinic, including Direct Access from Primary Care – in Clinical Oncology: a Journal of the Royal College of Radiologists (2019 October 18) reporting on the Brighton CUP team is interesting. To quote from the summary:

The Brighton cancer of unknown primary (CUP) clinic covers a population of about 650 000. As well as ‘in-house’ referrals, direct general practitioner referrals are also accepted (since 2015), aiming to shorten the diagnostic pathway and improve patient support. We present data from the first 3 years of activity.

RESULTS: In total, 258 patients were seen in the CUP clinic in the first 3 years. The median age was 71 years (range 23-95 years). Source of referral: general practitioner (30%); physician (27%); acute oncology (24%); other MDM (16%); surgeon (3%). A final diagnosis of cancer was made in 83% of referrals, with a primary site identified in 83% of those cancer cases: 19% haematological, 11% lung, 9% urological, 8% upper gastrointestinal, 6% breast, 5% skin, 4% gynaecological, 4% lower gastrointestinal, 0.3% thyroid and 0.3% sarcoma. 10% of referrals remained with a MUO diagnosis (not fit for further investigation) and 7% had confirmed CUP. 17% had a benign diagnosis (of which 56% were general practitioner referrals). Of the general practitioner referrals: 55% were seen in the CUP clinic, 31% did not meet referral criteria and 14% were declined after MDM review of imaging confirmed benign appearances.

CONCLUSION: The development of direct general practitioner referrals to CUP clinics nationally should be encouraged (as supported by the National Institute for Health and Care Excellence) – they are feasible and manageable within a tertiary CUP clinic, resulting in high rates of cancer diagnoses, with attendant early support from specialist nursing teams and oncological review