Patient pathway
The investigation and treatment stages of a cancer patient will look something like the diagram shown below. As we shall explain later, the problem for CUP patients begins at the time of diagnosis.
In addition to trying to identify everything possible about the cancer, the doctors will also be assessing overall fitness to help determine the patient’s tolerance for treatment options. Biological rather than chronological age will play a part here – for example, some 70 year olds can be mentally and physically 10 or more years younger biologically . The doctors will weigh-up 'quality of life' issues and patient wishes as part of determining how many, and which, tests to select.
Recognition of general cancer symptoms |
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Presentation of the symptoms to doctor |
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Investigation to find the Primary |
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Treatment Path(s) |
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Remission and / or death |
Unfortunately, we have to recognise that the management of CUP patients is complex and very variable (although the position in England, Wales and Norther Ireland should improve with the introduction of NICE Guidelines on CUP in the Summer of 2010). CUP patients may experience problems with the co-ordination and effective planning of investigations, treatments and holistic care through a lack of ‘ownership’ of the patient, in comparison with a patient who has an identified cancer.
The NHS are committed to providing all cancer patients with a Key Worker (often a cancer nurse specialist) to help ease the Pathway and give support during diagnosis and treatment. CUP patients should ask if no Key Worker is allocated once cancer is diagnosed. Click here for further information on palliative and supportive care .
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