Author:

Den-Lei Cudal, Senior Specialist Screening Practitioner 

Acknowledgement:

Rochelle Vaz-Assistant Service Manager and St Mark’s Bowel Cancer Screening Centre

Success Story

St Mark’s Hospital Bowel Cancer Screening Centre (STM BCSC) has a streamlined process of handing over patients to the symptomatic service upon diagnosis of bowel cancer. However, in 2021, 36% of these patients have breached or did not receive the first definitive treatment within 62 days from referral mainly due to their complex co-morbidities requiring further investigations and management prior to receiving cancer treatment and because of capacity.

A research study conducted by Hanna T, et. al (2020) have stipulated that even a 4-week delay in the treatment of cancer patients could increase their mortality rate by 6-13 percent. Henceforth, to address possible delays in the cancer treatment of newly diagnosed patients, STM BCSC has updated its process and added the following:

• Identifying the patient’s local hospital.
  • If they are local to St Marks Hospital, in addition to referring them for Multidisciplinary Team Meeting (MDT) and Surgical outpatient appointment (OPA), the patient should also be referred to the Pre-rehabilitation (Pre-hab) team. The aim is for the Pre-rehab team to assess and identify possible health concerns that needs to be managed prior to cancer treatment (i.e anaemia requiring ferritin infusion, weight management, cardiology input). The patients are usually seen by the Pre-hab team whilst they are waiting for their surgical OPA and treatment date therefore avoiding possible delays.
  • If the patient is local to Hillingdon Hospital, they are referred back within 24 hours after their colonoscopy and are seen in Surgical OPA within 24 hours after referral.

Scope

Upon diagnosis of bowel cancer during colonoscopy, the Specialist Screening Practitioner (SSP) will identify the patient’s local hospital and follow the pathway below (Figure 1 and Figure 2):

Objective

• Reduce cancer waiting times resulting to patients receiving their treatment within 62 days from referral and 31 days from DTT (Decision to treat).

Outcome

• As per the STM BCSC data there is a 5 percent decline in the number of cancer patients who breached from 2020-2021 to 2023-2024 this could be attributed to the collaborative work between STM BCSC, Pre-hab team and Hillingdon Hospital. Although the number of breaches have lessened it is also important to note that there was a general decrease in the number of patients diagnosed with bowel cancer over this 4 year period.

Learning points

• Working collaboratively with the multi-disciplinary team and having a streamlined process could positively impact the patient’s care which could lead to favourable treatment outcomes.

Sources

1. Hanna, T., King, W.,Thibodeau, S., Jalink, M., Pauline, G., Harvey-Jones, E., O’Sullivan, D., Booth, C., and Sullivan, R. (2020).Mortality due to cancer treatment delay: systemic review and meta-analysis. BMJ 2020;371:m4087. Available at: https://www.bmj.com/content/371/bmj.m4087
2. Local Trust Guidelines (2023). Procedures for Management of Patients with Diagnosis/suspicion of Cancer within the Bowel Cancer Screening Programme (BCSP). London: St Mark’s Bowel Cancer Screening Centre.

Appendices

Appendix A - Suspected Cancer Findings checklist