Early Diagnosis and Referral

There is evidence that patients with cancer attend health facilities a number of times with symptoms related to their cancer and are treated otherwise before onward referral.These protocols recommend that cancer patients be referred appropriately in a timely manner to the appropriate level of care where the specific service required in the care pathway is available. The patients should be triaged before referral based on their signs and symptoms.

These protocols recommend the following minimum timelines in order to minimize delays and improve outcomes:

  • Immediate referral will require admission acutely within a few hours of referral such as in oncological emergencies
  • Urgent referral will require a 14-day standard from referral to assessment in a cancer centre with rapid assessment by a designated clinician.
  • A 31-day standard from diagnosis to start of treatment (including for recurrent disease)

Designated clinicians should cooperate to ensure that an appropriate diagnostic work-up is provided for patients suspected to have cancer. The definitive diagnosis of cancer is confirmed by histopathological examination of the biopsy specimen. Patients confirmed with cancer should be referred without delay to the appropriate multi-disciplinary team (MDT) in the nearest facility providing cancer care.

There should be pre-booking systems for appointments at both referring and receiving clinics, where each patient with a new cancer diagnosis should be seen by an oncologist. The referring clinician should also be informed of the diagnosis and decision made.

Inter-Professional and Patient Communication

Communication needs to be timely and concise. The main communication points along the patient journey must include:

  • What the patient has been told about their condition
  • What written/other information was offered
  • Next steps – when the patient is being seen or treatment started
  • Intent of treatment (curative/palliative)
  • Summary of medication and alterations to medication
  • Contact details for further information/discussion
  • Specialist assessment and intervention summary
  • Treatment plan summary – when created and when amended
  • Written correspondence to be copied to all appropriate team members who have actions to undertake in the patient’s care.

Key points at which to communicate include: Diagnosis, multidisciplinary team discussions, assessment clinic, clinic appointment reviews, treatment reviews, decision points for changes in care planning and decision point for end-of‐life care planning

Stages of Referral pathway

Referral sources will include Accident and Emergency department, internal referrals from other departments and referrals from outside facilities among others.

Assessment and diagnosis

  • Consultant clinic appointment.
  • Investigations: of body function (renal, haemogram), imaging, fine needle aspiration cytology, biopsy; must be discussed to ensure individual good care
  • Diagnosis given to the patient.

Multidisciplinary team meeting

  • Agree on referral and minimum data for case presentation at the MDT meeting.
  • Outline treatment plan recommended (including surgery).
  • Communication to patient and referring clinician.
  • Paediatric and young adult cases to be discussed at appropriate Paediatric MDT

Treatment planning

  • Treatment plan explained to patient and next of kin with explanation of possible effects, reviews as necessary;
  • Contact details in case of oncologic emergencies like febrile neutropaenia;
  • Holistic needs assessment done;
  • Refer to specialist oncology rehabilitative service provider, as required

Pre-treatment assessment

  • To include general surgical assessment
  • Information prescription
  • Clinical assessment

Treatment

  • Surgery.
  • Radiotherapy
  • Systemic therapy
  • Best supportive care
  • After-care and rehabilitation plan agreed with patient
  • End of Treatment Summary completed on discharge (including details regarding follow‐up)
  • Early referral to local support team and community specialist palliative care services
  • Communication with referring clinician.

Follow-up/surveillance

  • Risk-stratified follow-up plan to guide investigation and follow-up
  • Function follow-up
  • Plan for pregnancy
  • Rehabilitation
  • Triggers for MDT discussion