Rapid Diagnostic Clinics (RDCs)
Rapid Diagnostic Centres (RDCs) are designed to speed up cancer diagnosis and support NHS ambitions to achieve earlier diagnosis, with improved patient experience, for all patients with cancer symptoms or suspicious results.
The UK two-week wait (2WW) initiative is aimed at reducing diagnostic and treatment intervals and is based on referral in with site-specific ‘red-flag’ symptoms. Patients with alarm symptoms are referred into hospital for fast-track assessment and those assessed with a low risk of cancer referred back to the GP.
However, only half of cancer patients ever develop alarm symptoms, instead many cancers present with vague or non-localising symptoms such as fatigue, weight loss or back pain. This group of patients is often diagnosed with cancer at a later stage.
RDCs begin by focussing on diagnosing patients with non-specific symptoms and who may go to their GP many times before being sent for tests.
They have been developed to provide an early assessment of:
symptoms & co-morbidities (health history),
polypharmacy (medications review),
lifestyle factors
and mental health
– alongside optimisation of nutritional status and general health.
Diagnostics (blood tests, ‘scopes and / or scans) are performed within one to two weeks to promote early diagnosis with prompt onward referral or discharge – as appropriate.
The aim is to roll out Rapid Diagnostic Clinics (RDC) nationally – once trialled in Vanguard Centres – but until now there has been little data assessing the effectiveness of RDC models in England (RDC’s are a Dutch initiative).
Guy’s Hospital RDC established a ‘vague symptoms pathway’ for GPs and internal referrals for patients with symptoms concerning for malignancy not suitable for other, site-specific, urgent referrals. This large study evaluated all patients referred to the Guy’s RDC between December 2016 and June 2019 (n = 1341) to assess the rate of cancer diagnoses, frequency of benign conditions and effectiveness of the service.
The cancer detection rate was 7%, (higher than many 2WW pathways, including the Guy’s colorectal pathway of 3%).
In addition, 180 serious non-cancer conditions were diagnosed in a third of patients necessitating referral to over 25 specialist teams.
The majority (2/3) were found to have a non-serious conditions that could be managed in primary care. This group was discharged back to GPs with recommendations for care…
Overall, the study found the Guy’s ‘vague symptom’ RDC to be an effective service with a median time to histological cancer diagnosis of 28 days – a significantly improved time to diagnosis than seen previously for this cohort of patients.
The full study, published 5th January 2021, is available to read here – https://www.nature.com/articles/s41416-020-01207-7