UK Study Assesses the Success of Non-Specific Symptom-Based Cancer Diagnosis Pathway

A comprehensive UK study has analyzed the effectiveness of a specialized cancer diagnosis pathway aimed at patients presenting with non-specific symptoms (NSS), such as unexplained weight loss or fatigue. These symptoms are indicative of a wide array of health issues, ranging from benign conditions to advanced-stage cancers, making early and accurate diagnosis particularly challenging in the primary care setting.

Published in The Lancet Primary Care, the research followed over 4,800 patients referred through the SCAN (Suspected CANcer) Pathway from 2017 to 2023. Led by researchers at the University of Oxford’s Nuffield Department of Primary Care Health Sciences, the study highlights key insights into the pathway's performance and diagnostic outcomes.

Funded and developed in collaboration with NHS England, Cancer Research UK, Macmillan Cancer Support, and the Oxfordshire region, the SCAN pathway was designed to expedite cancer detection for patients whose symptoms do not meet the criteria for urgent referrals. Since its adoption in 2020 across the region, it has formed part of the NHS's broader rollout of Rapid Diagnostic Centers nationwide.

Early diagnosis of cancer is crucial; it can significantly improve survival rates and reduce healthcare costs, as late-stage cancer treatments are more intensive and expensive.

Key findings from the study include:

• Approximately 8.8% of patients diagnosed with cancer, chiefly lung, pancreatic, breast, non-Hodgkin lymphoma, and colorectal cancers.
• Another 10.9% received diagnoses of serious non-cancer conditions.
• Around 19.3% had significant incidental findings, illustrating the complexity and resource demands of NSS pathways.
• Certain symptom profiles and test results, like abnormal CA125 levels, markedly increased the likelihood of a cancer diagnosis, with CA125 alone possessing a positive predictive value of nearly 30%.

Dr. Claire Friedemann Smith from the University of Oxford emphasized that pathways like SCAN are valuable for identifying hard-to-diagnose cancers. However, they also generate many incidental findings, which can strain healthcare resources. The study underscores the importance of appropriate resourcing and supports further investigation into the pathway's cost-effectiveness, especially given the high rate of non-cancer findings and the lack of a clear stage shift in diagnosed cancers.

Dr. Brian D Nicholson highlighted the necessity of balancing thorough investigation with avoiding unnecessary procedures. The research aims to enhance understanding of how to optimize these pathways, including identifying additional serious diseases discovered during follow-up. Overall, the findings reinforce the need for sustained support and refinement of NSS pathways within the NHS as similar models expand domestically and internationally.