NHS benchmarks and treatment model
Cancer treatment in England and Wales for the last decade has been directed by The NHS Cancer Plan (2000). This strategy covers the whole care pathway – from prevention, through early detection and treatment, to end of life care. It was supplemented by the Cancer Reform Strategy of 2007. This in turn has been "refreshed" by the Coalition Government who introduced Improving Outcomes: a Strategy for Cancer in January 2011.
The NHS standard target interval between urgent GP referral and first hospital appointment is 2 weeks. But many Trusts have established rapid access services for patients with possible cancer, to ensure they are seen as quickly as possible. They also seek to minimise waits for individual diagnostic procedures such as endoscopy, CT scans.
NICE Guideline on CUP
The NHS NICE Guideline on CUP (effective 26 July 10) gives clinicians carefully constructed, evidence-based, approaches to different CUP presentations. It recommends that CUP is clasified into 3 categories:
- Malignancy of undefined primary origin. Metastatic malignancy with no primary site identified after a limited number of examinations and tests.
- Provisional carcinoma of unknown primary (provisional CUP). Metastatic (epithelial or neuro-endocrine) malignancy, identified on the basis of histology/cytology, with no primary detected after wide-ranging investigations.
- Confirmed carcinoma of unknown primary (confirmed CUP). No primary detected after specialist reviews and further specialised tests if required.
Click here to read a review article on the Guideline.
Other Guidance. There are less comprehensive "European" guidelines on CUP and an interview with the lead author, written for clinicians, summarises his view on CUP. For the latest thinking (2011) by Greco & Hainsworth - the world's leading authorities on CUP based in the USA - see their chapter on CUP in our Archive. Note: this is written for clinicians and scientists and is included here for those with medical knowledge; but may be of interest to some patients and carers with a basic science understanding.
The NHS treatment model is based on cancer care being delivered in specific, designated cancer centres and cancer units (and occasionally at home) by co-ordinated services in partnership with each other.
- Cancer units, often units of District General Hospitals, are usually where people are diagnosed and cancer is confirmed and the patient is then referred to an oncologist or the specialist CUP Team whic includes and oncologist. Staff here will have strong links with the oncology centre (see below). Oncologists may go out from the centres to see people in the units. More complex treatments or rarer cancers may go to the cancer centres where there is a higher level of expertise. Some cancer units have their own chemotherapy suites.
- The cancer centre may be a large hospital or a university teaching hospital with facilities for radiotherapy, chemotherapy and with links to palliative care. Not all cancer centres do surgery and the specialist cancer surgery may be done at the cancer units (Usually by a surgeon who specialises in cancer surgical procedures.)
- Satellite services, such as in patient's homes, where non complex treatment may be delivered.
The District General Hospital (DGH) and Cancer Centre will come within a Cancer Network. In general, within any Cancer Network, visiting oncologists at a DGH treating a particular cancer are the same people treating the cancer at the Cancer Centre.
- For "known" cancer sites, oncologists are supported by a “Network site-specific group” (e.g. a Lung cancer SSG) - a group of medical experts will weekly, or sometimes fortnightly, in a Multi Disciplinary Team to discuss each patient’s treatment pathway.
- In the case of CUP, the 2010 NICE Guideline wants suspected CUP patients seen quickly by a specialist CUP team. The Guideline recommends a CUP MDT at Network level to review problematic cases.
- The aim will be to identify a primary with confidence as soon as possible in the pathway and refer the patient to a site specific MDT.
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