NICE calls for specialist cancer teams to boost patient care

Article: 8039638 doctor notesSpecialist cancer teams should be set up to improve the care and treatment of patients whose cancer has spread to other parts of the body from an unknown primary location, NICE says.

Around 10,000 people are diagnosed with cancer of unknown primary origin (CUP) in England and Wales every year, making the disease one of the most common causes of cancer death.

However, current levels of care for patients with CUP are patchy, with many patients missing out on the high-standards of care on offer to patients with site-specific cancers such as breast and bowel.

This latest guidance calls for a re-organisation of cancer services to boost care for this group of patients, and has received the support of the National Cancer Peer Review Programme in England, which is developing a number of peer review quality measures,

Hospitals will be expected to follow the measures and are assessed against them with the aim of improving care for cancer patients and their families.

Under the plans, all hospitals with a cancer centre or unit should set up specialist CUP teams to support and manage the care of patients with this diagnosis. This team will be responsible for guiding patients' care until they are referred to a consultant with expertise in a particular type of cancer, referred for palliative care alone or are finally diagnosed with confirmed CUP.

Specialist CUP Multi Disciplinary Teams should be set up at a Network level to review the treatment and care of patients with confirmed CUP, or with complex diagnostic issues.

NICE also calls for every cancer network to establish a group responsible for managing all stages of CUP.

Professor Peter Littlejohns, NICE Clinical and Public Health Director, said: “We are pleased that the National Cancer Peer Review Programme in England is taking note of our guideline and looking to use it to improve services.

“It is important that patients with this form of cancer receive the same level of care that other cancer patients experience. This guideline seeks to provide a consistent, national approach to the diagnosis and management of this condition.”

Dr Andrew Fowell, Guideline Development Group (GDG) Chair and a Macmillan Consultant in Palliative Medicine at Eryri Hospital, North Wales, said: “Just as specialised teams help care for patients with a site-specific cancer such as breast, prostate, bowel or liver, the same needs to exist for those with CUP. These teams can provide great support for cancer patients and better one-on-one care.

"We expect some oncologists to become CUP specialists, alongside their more conventional site-specific activities. They will be supported by CUP Nurse Specialists, Palliative Care physicians, and other core diagnostic staff. These teams should be supported by their hospitals to ensure they are given sufficient time in their job plans for this specialist role and any training that may be needed."

Dr David Brooks, a member of the GDG and Macmillan Consultant in Palliative Medicine at Chesterfield Royal Hospital, helped to establish a specialist CUP team earlier this year.

He said: “Our Unknown Primary Team consists of existing members of the Upper GI Cancer and Palliative Care teams. We see one or two patients per week in a Cancer Unit that covers a population of just over 300,000 so the workload is not onerous.

“It is early days but we are already seeing benefits in both providing early supportive and palliative care, more effective targeting of investigations to confirm treatable disease and, in those who are not fit for treatment, stopping inappropriate tests and re-focusing care towards arranging appropriate support and palliation to enable the patient to get home.”

Dr Richard Osborne, GDG lead clinician and Consultant in Medical Oncology, Dorset Cancer Centre, added:“This guideline will provide a sound basis for healthcare professionals to ensure patients are informed and their care is centred around their needs and wishes.”

Listen to Dr Obsorne discussing this guidance and the benefits it will bring to patients.

26 July 2010

This page was last updated: 26 July 2010

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.