Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation

M T Martínez; J Montón-Bueno; S Simon; B Ortega; S Moragon; S Roselló; A Insa; J Navarro; A Sanmartín; A Julve; E Buch; A Peña; J Franco; J Martínez-Jabaloyas; J Marco; M J Forner; A Cano; A Silvestre; A Teruel; A Lluch; A Cervantes; I Chirivella Gonzalez

doi:10.1016/j.esmoop.2021.100148

Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation

ESMO Open. 2021 Jun;6(3):100148. doi: 10.1016/j.esmoop.2021.100148. Epub 2021 May 11.

Authors

M T Martínez¹, J Montón-Bueno¹, S Simon¹, B Ortega¹, S Moragon¹, S Roselló², A Insa¹, J Navarro³, A Sanmartín⁴, A Julve⁵, E Buch⁶, A Peña⁷, J Franco⁸, J Martínez-Jabaloyas⁹, J Marco¹⁰, M J Forner¹¹, A Cano¹², A Silvestre¹³, A Teruel¹⁴, A Lluch¹, A Cervantes¹⁵, I Chirivella Gonzalez¹⁶

Affiliations

¹ Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
² Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain.
³ Management Department, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; CIBERESP (CIBER de Epidemiología y Salud Pública), Centro Nacional de Epidemiología del Instituto de Salud Carlos III, Madrid, Spain.
⁴ Management Department, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
⁵ Department of Radiodiagnosis, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
⁶ Department of Surgery, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
⁷ Department of Medicine Digestive, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
⁸ Department of Pneumology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
⁹ Department of Urology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
¹⁰ Department of Otolaryngology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
¹¹ Department of Internal Medicine, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
¹² Department of Gynecology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
¹³ Department of Traumatology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
¹⁴ Department of Hematology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
¹⁵ Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain. Electronic address: andres.cervantes@uv.es.
¹⁶ Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain. Electronic address: chirivella_isa@gva.es.

Abstract

Background: Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation.

Patients and methods: Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process.

Results: A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis.

Conclusions: The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting.

Keywords: cancer; early diagnostic; primary care.

MeSH terms

General Practitioners*
Humans
Lung Neoplasms*
Medical Oncology
Primary Health Care
Referral and Consultation