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Guideline promises to transform cancer care for patients

NICE guideline for people with cancer from an unknown origin

Adrian O'Dowd

Monday, 26 July 2010

New efforts are being launched today to help the sometimes-neglected group of people whose cancer has spread to other parts of the body from an unknown primary location.

Specialist cancer teams will be created to improve the care and treatment of these patients as part of a re-organisation of cancer services.

The National Institute for Health and Clinical Excellence (NICE) wants to address the inequality in care these patients often receive compared with people who have a specific type of cancer such as breast, lung or prostate.

NICE is today launching a guideline with the backing of the National Cancer Peer Review Programme in England, which is studying the recommendations to develop a number of peer review ‘quality’ measures that hospitals will have to follow.

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.

“This type of cancer is known as metastatic malignant disease of unknown primary origin or more commonly, cancer of unknown primary. It is very much a neglected cancer - patients generally have a poor prognosis and little is known about which types of treatment work best for them.

“They also tend to miss out on medical and other benefits that are given to patients with a specific type of cancer because of a lack of information, understanding and specialised 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.”

There are an estimated 10,000 people each year are diagnosed with cancer of unknown primary (CUP) in England and Wales but many do not receive the same level of care as other cancer patients.

Crucial to the effort to improve care for these patients will be the development of specialised teams at local, regional and national level.

The guideline recommends that all hospitals with a cancer centre or unit should establish 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 also be set up at network level to review the treatment and care of patients with confirmed CUP, or with complex diagnostic issues.

Every cancer network should also establish a group responsible for managing all stages of CUP.

Dr Andrew Fowell, guideline development group chair and a Macmillan consultant in palliative medicine at Eryri Hospital, Wales, said: “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."


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