Best practice pathway guides

Best practice prostate pathway guide

Best practice Oesophago and gastric cancer pathway guide 

Best practice lung cancer pathway guide

Best practice colorectal cancer pathway guide

These guides were initially developed as project briefs to support systems to implement the best practice pathways. They have been revised slightly to ensure they are current but still contain lots of valuable information which will support healthcare professionals at the front-line of cancer diagnosis, in order to deliver best practice diagnosis, treatment and support.

Straight to Test (STT) pathways (where a diagnostic procedure is arranged as the first episode of care), enable patients to be given a diagnostic appointment within 2WW in place of an outpatient appointment. The advantage of an STT pathway is that it can reduce the time period from referral to diagnosis, and also enable earlier treatment (for example with STT endoscopy). Additionally, it can improve patient experience by reducing the number of attendances required, as well as providing earlier assurance of diagnosis.

A clear understanding of the clinical pathways for each tumour site pathway enables development of referral criteria to identify patients suitable for STT pathways.

Delivering timely cancer pathways is crucial for the following reasons:

  1. Despite improving survival rates, cancer is the fourth leading cause of death in the UK;
  2. Patients continue to present late to their GP with their symptoms, resulting in delayed referral;
  3. There is variation in two week wait (2WW) referrals across the country suggesting that GPs are not always identifying suspicious symptoms;
  4. Once a patient has been referred, they want to be told “It’s not cancer” as soon as possible or have their treatment planned in a timely manner;
  5. Where the diagnosis is cancer, a speedy diagnostic pathway is critical for 62 day compliance.

These latter two points, (4 and 5), support the ‘new’ NHSE performance standard for cancer patients. The ‘Faster Diagnosis Standard’, which will be introduced in 2021/22, emphasises the importance of receiving a diagnosis or ruling out of cancer within 28 days.

We recognise that this is a challenging standard to meet and that services must be prepared to have a period of time where resources must be increased in order to reduce waiting times at the beginning but this will settle back down to numbers that are representative of business as usual. The benefits of implementing the recommendations in these papers however, can be significant:

For patients:

  • Speeding up the time between a suspected cancer referral and diagnosis
  • Empowerment from information about the diagnostic process, with information provided at point of referral
  • Reduced anxiety and uncertainty of a possible cancer diagnosis, with less time between referral and hearing the outcome of diagnostic tests
  • Fewer visits to the hospital for patients and families, by providing information over the telephone or by letter and coordinating diagnostic tests

For clinical teams

  • Working across primary and secondary care to ensure high quality referrals into a streamlined service that gets the patient to the right place, first time
  • Improved ability to meet increasing demand and ensure best utilisation of highly skilled workforce and resources
  • Alignment with timed pathways and the implementation of the e-referral service
  • Reduced demand in outpatient clinics with the use of other methods of communication such as phone calls and letters to inform a patient of a diagnosis.