Rebecca Rennison, Target Ovarian Cancer’s Director of Public Affairs and Services, has been working to make sure NHS England’s new approach to speedier diagnosis works for women with ovarian cancer. She brings us an update on the multidisciplinary services, and why they must be rolled out in full to speed up ovarian cancer diagnosis and save lives.
The 2015 Cancer Strategy for England recommended a pilot of multi-disciplinary diagnostic services for vague or unclear symptoms. The new services don’t replace existing referral guidelines or pathways, but they do offer an extra option for GPs when they know something is wrong, but are not exactly sure what or where best to refer a patient.
Bouncing between a GP and diagnostic tests
Under current guidelines for GPs, if a woman were examined by her GP and an abdominal mass or ascites were found, she would be referred on the urgent two week pathway. Likewise, if a woman presented with persistent bloating, she would likely be referred for a CA125 blood test and on from there. But ovarian cancer symptoms can be vague, and experiencing symptoms like tummy pain, loss of appetite or weight loss could indicate a number of cancers. In this case a person could bounce between one part of the NHS for testing, back to their GP if the first tests come back negative, then back down another pathway for a different set of tests. Our most recent Pathfinder study found that nearly half of all women were initially referred for tests for something other than ovarian cancer, only to find themselves being bounced back and forth between the GP and a hospital or clinic for further tests.
A fresh approach to ovarian cancer diagnostic tests
The new pilot approach offers a simple way for a woman’s GP to refer her into secondary care for different cancers to be either diagnosed or ruled out. Together with colleagues from Cancer52, I heard from clinicians working directly at two of the multidisciplinary pilot sites in NHS Leeds and NHS Airedale, Wharfedale and Craven.
What’s in a name?
These pilots have been referred to by a range of names – for example, one stop shops or rapid diagnostic centres, some of which can be confusing. These multidisciplinary services are not necessarily in one place. What is significant is the services they bring together, the shared expertise and the working across primary and secondary care. Likewise, many of the services offered simply cannot be a one stop shop – for example, a combination of endoscopies and blood tests would see patients fasting for an extended amount of time and being subject to a plethora of tests all in one go. In reality these tests take place over a brief period of time, but separately. Therefore, to give these pilots their proper title, they are rapid multidisciplinary diagnostic services.
What is the future for multidisciplinary diagnostic services?
While the pilots are still at a relatively early stage – it takes many years to bring in the kind of change in cancer diagnosis that this work envisions – we are learning more about how effective these services are, and how to make improvements. One benefit of the new approach is that it relies on GPs ordering a range of diagnostic tests before referring patients into the multidisciplinary service. This in itself picks up cancers that might otherwise have been missed without patients even being referred on, as it lowers the threshold for GP testing and includes tests for a wide range of possible diagnoses, including ovarian cancer.
The rapid multidisciplinary diagnostic services we heard about are still pilots and their future is uncertain. The evidence may be in its early stages, but it is clear that this approach is an effective way of ensuring no cancer diagnosis is missed. They provide a much smoother pathway to diagnosis, bring together primary and secondary care clinicians at a local level and offer a better degree of service and support to those facing a cancer diagnosis.
At the recent Conservative Party Conference, the Prime Minister committed to investing in improving cancer diagnoses. We hope that the Prime Minister’s announcement guarantees the future of these pioneering services, and will pave the way to a future where speedy ovarian cancer diagnosis is a reality.