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. 2021 Nov;125(11):1503-1510.
doi: 10.1038/s41416-021-01544-1. Epub 2021 Sep 6.

Characterisation and outcomes of patients referred to a regional cancer of unknown primary team: a 10-year analysis

Mark Stares  1   2 , Karin Purshouse  2 , Gillian Knowles  1 , Rachel Haigh  1 , Jenny Irvine  1 , Aoife Gatenby  1 , Rebekah Patton  1 , Jo McGinty  1 , Alan Christie  1 , Marjory MacLennan  1 , Colin Barrie  1 , Sally Clive  3
Affiliations

Characterisation and outcomes of patients referred to a regional cancer of unknown primary team: a 10-year analysis

Mark Stares et al. Br J Cancer. 2021 Nov.

Abstract

Background: In the United Kingdom, national guidance published in 2010 recommended the establishment of specialist teams to improve clinical pathways for patients presenting with malignancies of undefined primary origin (MUO) and cancer of unknown primary (CUP). This study sought to define outcomes of patients referred to a regional MUO/CUP service.

Methods: Data were collected prospectively on all patients (n = 1225) referred to a regional CUP team over a 10-year period. Patient demographics, clinical, pathological and outcome data were recorded and analysed.

Results: Confirmed CUP (cCUP) was diagnosed in 25% of patients. A primary metastatic cancer was identified in 36%, 5% were diagnosed with provisional CUP (pCUP), 27% retained the diagnosis of MUO and in 8% a non-cancer diagnosis was made. Median survival was low in all patients with a final malignant diagnosis: primary identified 9.0 months, cCUP 4.0 months, pCUP 1.5 months and MUO 1.5 months.

Conclusions: Patients presenting with MUO have poor outcomes irrespective of the final diagnosis. These patients need a patient-centred, streamlined, rapid diagnostic pathway. There are clear benefits to primary and secondary care teams having access to a dedicated, multidisciplinary MUO/CUP service, with clinical nurse specialists supporting the patients, to help facilitate this pathway and ensure early oncology review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Kaplan–Meier curves examining survival for all diagnostic groups.
p < 0.001 (log rank).
Fig. 2
Fig. 2. Time (days) from first radiological suspicion of MUO to key timepoints in the patient journey.
Error bars represent interquartile range.
See this image and copyright information in PMC

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