The ACE Programme. Multidisciplinary Diagnostic Centres (Wave 2) Cancer Cascade Reading, 22nd November 2018

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1 The ACE Programme Multidisciplinary Diagnostic Centres (Wave 2) Cancer Cascade Reading, 22nd November 2018 Veronique Poirier ACE Programme Data Manager

2 Title ACE Programme overview An early diagnosis initiative to Accelerate, Coordinate and Evaluate (ACE) innovative approaches, with the aim of sharing learning and good practice ACE Wave 1: completed A range of projects across England evaluated a variety of initiatives to improve earlier diagnosis of cancer and develop the evidence-base ACE Wave 2: evaluating 5 projects across England developing & trialling Multidisciplinary Diagnostic Centre (MDC) based pathways Focus on patients with non-specific but concerning symptoms ACE Objectives: Faster diagnosis (cancer or other) Shift from late > early stage diagnosis Reduce diagnoses via emergency presentation Improve patient experience

3 Title Multidisciplinary Diagnostic Centre (MDC) Airedale, Wharfdale & Craven MDC site: Airedale General Hospital Leeds MDC site: St James University Hospital (Specialist Cancer Centre) Greater Manchester MDC sites: Manchester University NHS Foundation Trust (Wythenshawe Hospital) and The Northern Care Alliance (Royal Oldham Hospital) Oxford MDC site: Oxford University Hospital Trust (Specialist Cancer Centre) London MDC sites: North Middlesex University Hospital, University College London Hospital (Specialist Cancer Centre), Southend University Hospital, Queens (BHRUT) and the Royal Free Hospital

4 Title The theory behind MDCs a patient centred approach Figure 1. How Multidisciplinary Diagnostic Centres could improve early cancer diagnosis. Reproduced with permission from Cancer Research UK.

5 Title Developing our understanding - NCDA National Cancer Diagnosis Audit (NCDA) data 2014 diagnoses 17,042 cancers in total cohort 2,865 cancers presented with non-specific symptoms, or vague (17% of total) 10,333 cancers presented with at least one obvious symptom (61%) 3,844 cancers had no symptoms recorded: screening/not known (22%) Vague Obvious %

6 Title Developing our understanding - NCDA Vague Obvious Vague Obvious % % Number of primary care consultations 5 0 Stage o Longer diagnostic interval more likely for patients with vague symptoms (median) o Late stage diagnosis more common for patients with vague symptoms Interval Vague Obvious Stage Vague Obvious Presentation to referral Presentation to diagnosis Presentation to first seen 11 days 2 days 47 days 38 days 25 days 18 days 1 10% 26% 2 13% 18% 3 16% 15% 4 32% 21%

7 Title MDC cohort details (up to 28 th Feb 18) MDC Number of cases Median age Patient age range % female Airedale Great Manchester Royal Oldham Wythenshawe Leeds London Queen (BHRUT) North Middlesex Royal Free UCLH Oxford Total 1, NB: Different/staggered go-live dates, from Dec 16 to Jan 18 NB: Oxford minimum age criteria >40 yrs

8 Title Cancer diagnoses by MDC (up to 28 th Feb 18) MDC Number of cases Number of cancers Conversion rate Great Manchester Airedale Royal Oldham Wythenshawe Leeds London Queen (BHRUT) North Middlesex Royal Free UCLH Oxford Total 1,

9 Title MDC early findings (up to 28 th Feb 18) Main presenting symptoms were: weight loss; nausea and loss of appetite and abdominal pain 53% reported symptoms had started more than 3 months prior to MDC referral (based on 2/3 records) 142 cancer diagnoses (9% conversion rate) 60% of cases have staging data of those 25% are early stage Over 34% of patients were given at least one non-cancer diagnosis

10 Title Cancer diagnoses distribution (up to 28 th Feb 18) 25% 20% 15% 10% 5% 0%

11 Title Cancer type in top 5 categories Broad category Upper GI Main cancer type N Malignant neoplasm of pancreas 11 Malignant neoplasm of liver and intrahepatic bile ducts 7 Malignant neoplasm of stomach 6 Lung Malignant neoplasm of bronchus and lung 25 Urology Malignant neoplasm of kidney, except renal pelvis 11 Malignant neoplasm of prostate 9 Haematology Follicular (nodular) non-hodgkin's lymphoma; Diffuse non- Hodgkin's lymphoma 10 Lower GI Malignant neoplasm of colon 13

12 Title Early results show (up to 28 th Feb 18) o MDCs are well configured to diagnose hard to detect cancers: Majority of diagnosed cancers associated with broad symptoms with varying or low predictive values o MDCs providing a diagnostic framework for clinically complex patients with NSCS: Over 34% of patients diagnosed with non cancer conditions o MDCs providing a rapid, planned referral route 50% of cancer patients given their diagnosis within 28 days o MDC pathway providing earlier diagnosis for patients with NSCS

13 Title A positive patient experience o Patients felt supported throughout MDC pathway: 85% of patients responded positively to the question Effectiveness of people working together to provide the best possible care for patients (61.2% CPES 2016) 86% felt they had all the information they needed about tests on the day 81.1% reported that test results were explained in a way that could be understood (79.1% CPES 2016) 97.3% responded positively to being given the opportunity to ask questions o MDCs providing rapid diagnoses for patients within planned routes of care: 89% of patients felt the length of time it took for the tests to be done was about right

14 Title MDC high-level design features All MDC sites incorporate the following: Rapid referral Rapid & managed referral for complex patients with non-specific symptoms Defined symptoms criteria supports consistent & appropriate referral Patient focused Clinical triage & decision making based on detailed CNS assessment Patient supported through process from referral > diagnosis & onwards Multidisciplinary Diagnostic tests in quick succession, based on patients needs Enhanced clinical collaboration across 1⁰ & 2⁰ care boundaries Responsible for resolving symptoms Diagnosis (appropriate cancer pathway, non cancer pathway, return to GP, all clear given / serious disease ruled out) Information on the 3 varying approaches identified at programme level is available at Final programme evaluation will be through a series of papers over winter 18/19

15 Title Supporting local MDC planning & development ACE has been working with the MDC projects to develop a series of resource materials in support the planning and development of local MDC-based pathways. A guide outlining a potential approach is now available at which includes information on: MDC data items & metrics MDC design principles MDC patient experience survey findings Clinical perspectives on MDC challenges & benefits released Oct 18 Project catchment & referral estimates released Oct 18 Further news and information will be shared on the ACE website and via a dedicated newsletter contact ACEteam@cruk.org.uk to sign-up for alerts.

16 Title In summary, MDCs are currently Providing rapid diagnoses for patients within planned routes of care Achieving a cancer conversion rate of 9% Diagnosing cancers predominantly associated with broad symptoms with varying or low predictive values Providing a useful diagnostic framework for clinically complex patients who are unwell Providing support to patients throughout the diagnostic elements of the pathway

17 Title Acknowledgments MDC project leads: Dawn Gulliford (Airedale), Karen Blackburn and Susan Sykes (Greater Manchester), Helen Ryan (Leeds), Felicity Carson (London), and Zoe Kaveney (Oxford) Project clinical teams from: Airedale General Hospital, Manchester University NHS Foundation Trust (Wythenshawe Hospital) & The Northern Care Alliance (Royal Oldham Hospital) Leeds St James University Hospital (Specialist Cancer Centre) London: North Middlesex University Hospital, University College London Hospital (Specialist Cancer Centre), Southend University Hospital, Queens (BHRUT) & the Royal Free Hospital Oxford University Hospitals Trust (Specialist Cancer Centre) ACE evaluation leads: Dave Chapman, Véronique Poirier, Clare Pearson, Karen Fitzgerald Policy Research Unit cancer evaluation team: Stephen W. Duffy, Daniel Vulkan Further information about the Programme can be found at the team at