Background The Urgent Suspected Cancer (USC) referral pathway was introduced by the department of health in 2000 to reduce delays in the diagnosis and treatment of cancer. The model’s efficacy has been questioned in both paediatric and adult practice due to the very low pick-up rates of cancer in patients referred via this pathway. This study evaluates the role of the USC pathway and compares this to the actual referral routes of children and young people diagnosed with cancer.
Methods USC referrals to a single Paediatric Shared Care Oncology Centre over a 4-year period (01/2009–12/2012) were obtained from the local cancer registry. These were retrospectively analysed looking at demographics, reason for referral and diagnosis. A local oncology database was examined to identify actual referral pathways for children diagnosed with cancer over the same time period.
Results Out of the 118 children referred via the USC pathway in the 4-year period, 2 (1.7%) were diagnosed with cancer. The number of USC referrals has increased annually from 17 in 2009 to 47 in 2012. Data were available for 107 children (median age 7.5 years [range 0.1–16.9]). The most common reason for referral was suspected haematological malignancy (64%) with lymphadenopathy accounting for 98% of referrals. Suspected brain tumours accounted for 15% of referrals, 80% with headache. No haematological or brain malignancy was diagnosed. Concomitantly, 38 new malignancies (median age 4.4 years [range 0.21–16.8]) were diagnosed divided between: haematological (34%), brain (24%), Wilms (8%), neuroblastoma (8%), germ cell (8%), bone/ soft tissue (5%), and other (13%). The actual referral routes were 22 (58%) from the emergency department, 6 from other hospital specialities, 5 from routine paediatric outpatient, 4 from imaging arranged by their general practitioner (GP) and 1 directly referred by the GP.
Conclusion The pick-rate for paediatric cancers in the USC clinic at our institution was 1.7%. The majority of actual cancer diagnoses came via the emergency department. We would advise that when there is immediate clinical concern, cases should be discussed with the paediatrician for same day assessment. Alternatively for less urgent cases explore other referral routes specific to local service requirements.