Introduction

The route to diagnosis (RTD) for many TYA patients is unsatisfactory, or at least perceived to be so. The “Too Young to Get Cancer?” project undertook an analysis of all healthcare contacts on the cancer diagnostic pathway in TYA.

Method

Data was extracted from source in both primary and secondary care. Details of every healthcare contact from presentation to first cancer treatment were captured and this data was translated into a pathway map.  Each map was reviewed to identify potential missed opportunities for a more timely diagnosis, highlight good practice and define key events and intervals in the diagnostic pathway.

Results

105 TYA were recruited (overall response rate 63%). 93% of TYA consulted primary care prior to diagnosis. Using established RTD definitions, 45% of patients were referred via Two-Week Wait pathways, 38% emergencies, 11% via GP referrals, 6% other outpatient routes and 1 patient via screening. RTD and diagnostic interval varied by diagnostic group. The longest median diagnostic interval was observed in bone sarcoma patients. Within other diagnostic groups marked variation in diagnostic intervals was also observed. Of the evaluable pathways, 40% were deemed to represent good practice. 44% of pathways were evaluated as requiring room for improvement (clinically, organisationally or both), 16% were considered less than satisfactory. This varied between diagnostic groups.

Discussion

This unique analysis of the entire diagnostic pathway for TYA has revealed the marked variation in diagnostic pathways, patient experience and specific challenges to diagnosing cancer in this age group both within primary and secondary care.

Authors

Pring. TYA Cancer Service South West, Bristol Haematology and Oncology Centre

Nechowska. TYA Cancer Service South West, Bristol Haematology and Oncology Centre

Cargill. TYA Cancer Service South West, Bristol Haematology and Oncology Centre

R.Cox. Department of Paediatric Haematology, Oncology and Bone Marrow Transplant Bristol Royal Hospital for Children

A Wint. Macmillan Cancer Lead, South Gloucestershire

Stevens. TYA Cancer Service South West, Bristol Haematology and Oncology Centre

R.Dommett. Department of Paediatric Haematology, Oncology and Bone Marrow Transplant Bristol Royal Hospital for Children

 TYA Cancer Service South West, Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust