ESTRO 2025 - Abstract Book

S1559

Clinical – Mixed sites & palliation

ESTRO 2025

3515

Digital Poster Malignancy of Unknown Origin service - avoiding unnecessary investigations and improving treatment times, with high patient and colleague satisfaction Laura Jones, Lynne Breeze Jones, Sarah Williams, Martin Rolles, Sarah Gwynne Oncology, South West Wales Cancer Centre, Swansea, United Kingdom Purpose/Objective: Malignancy of unknown origin (MUO) is defined as metastatic disease identified on basis of limited tests, prior to tissue biopsy. Patients typically present via a number of routes, with a variable diagnostic workup. A weekly MUO MDT was already in place, but in 2020 a MUO outpatient referral pathway and weekly clinic was also established. This was staffed by an oncologist and a nurse specialist. We introduced a flag for radiology reporting, signposting the requestor to the MUO clinic, if relevant, along with developing a dedicated an outpatient biopsy pathway for MUO patients. Here we present the impact of these changes. Material/Methods: A retrospective audit was undertaken of a 1-year cohort of MUO MDT patients pre-pathway and a comparative cohort from April 22-March 23, post-pathway, to assess the impact of the new service on proportion of patients presenting as an emergency, in-patient days during diagnostic pathway, and compliance with national waiting time targets for time from point of suspicion (POS) of cancer to first definitive treatment. We also undertook a survey of patient and colleague satisfaction. Results: Results are shown in table. We found a reduction in suspected cancer pathway (SCP) time from 44 to 37 days (-7 days), reduction in time from POS to SACT from 83 to 63 days (-20 days) and RT from 60 to 25.5 days (-34.5 days). The proportion admitted during SCP reduced from 74% to 60%, with number of days in hospital during SCP reduced by a mean of 5.8 days from 13.8 to 8 days. Early oncology input identifies patients who are either too unwell for, or would not want treatments such as SACT, thereby avoiding over-investigation that would not change management. Audit confirms reduction in number of patients having biopsy without proceeding to active cancer treatment from 43% to 32%. 100% of patients reported satisfaction with consultation, felt listened to and supported. Colleagues rated usefulness of the service as 4.9/ out of 5. Conclusion: The introduction of a dedicated referral pathway and clinic has led to shorter time to diagnosis and treatment and reduced length of inpatient stays, with high patient and colleague satisfaction. Earlier involvement of the MUO specialist team avoids investigations that do not change management, which is of particular importance in patients with a poor prognosis, allowing emphasis on symptom management and quality of life, over extensive and unnecessary workup. This was also associated with a health economic benefit.