RT Journal Article
SR Electronic
T1 Integration of a patient-centred MUO/CUP service within a new acute oncology service: challenges and rewards
JF Future Healthcare Journal
JO Future Healthc J
FD Royal College of Physicians
SP fhj.2020-0044
DO 10.7861/fhj.2020-0044
A1 Sonali Dasgupta
A1 Wendy B Hyland
A1 Conn Haughey
A1 Sohail Mughal
A1 Adam Henry
A1 Celia Diver-Hall
YR 2020
UL http://www.rcpjournals.org/content/early/2020/11/12/fhj.2020-0044.abstract
AB Background Holistic approach to the clinical management pathway for malignancy of undefined primary origin (MUO) / carcinoma of unknown primary (CUP) patients remains an unmet clinical need. To address this, an MUO/CUP service was implemented during conception of a new acute oncology service (AOS).Methodology Over a comparable 17 months' duration, patient outcomes pre-MUO/CUP service implementation was retrospectively analysed and compared prospectively with post-service implementation database. Performance measures of MUO/CUP service were compared against national recommendations.Results In the retrospective cohort (n=32), median age was 71.5 years and median length of hospital stay (LOS) was 11.25 days. In the prospective cohort (n=42), median age was 75.5 years, median LOS was 7.75 days (p=0.037). Post-service implementation, 100% patients were discussed in MUO/CUP multidisciplinary team meeting; 96% of inpatient referrals were reviewed by oncology within 24–48 hours. In the prospective group, median overall survival (OS) was 73 days vs 35 days in the retrospective group (p=0.045; hazard ratio (HR) 1.61). Out of 20 patients suitable for anti-cancer treatment in the prospective group, 85% were treated within 31 days from the decision-to-treat; 90% were treated within 62 days of referral. Within the prospective group, median OS was 214 days in the treated sub-group, compared with 44 days in patients receiving best supportive care only (p<0.0001; HR 3.19).Conclusion Timely specialised input from AOS with a dedicated MUO/CUP team can achieve enhanced patient-centred and healthcare-centred outcomes, both in terms of survival and hospital stay. However, heterogeneity in both retrospective and prospective study groups, as well as discrepancies in coding, makes direct comparison between both groups challenging.