18 Transforming the prostate cancer pathway by incorporating same-day multiparametric prostate mri (mpmri) scans and prostate biopsies – prompt diagnosis with improved cancer waiting times. (31st October 2017)

• Record Type: Journal Article
• Authors: Cohen, Daniel; Roy, Ashoke; Kaul, Asheesh; McCarthy, Fionnuala; Smith, Gillian; Singh, Paras
• Is Part Of: BMJ leader. Volume 1(2017)Supplement 1
• Page Start: A10
• Page End: A11
• Publication Date: 2017-10-31
• Subjects: Medical personnel -- Periodicals; Leadership -- Periodicals; Medicine -- Practice -- Management -- Periodicals; Health services administration -- Periodicals; 610.68
• DOI: 10.1136/leader-2017-FMLM.18
• Languages: English
• ISSNs: 2398-631X

Abstract

Abstract : Aims: Prostate cancer diagnosis clinics traditionally utilise clinical examination, PSA test and prostate biopsy. Increasing evidence suggests pre-biopsy prostate mpMRI enables targeting of lesions or avoidance of biopsy altogether. However, incorporating mpMRI into the pathway challenges compliance with national cancer targets (NCTs). Our aim was to create a high quality prostate diagnostic pathway with same day mpMRI and prostate biopsies, enabling efficient prostate cancer diagnosis and treatment. Methods: Retrospective analysis of key performance metrics (waiting times) in 318 referrals was undertaken prior to (2014), during (April – May 2016), and after (July – Nov 2016) implementation of the pathway. The overall impact on the 62 days NCT pathway compliance was assessed. Results: All key metrics significantly improved following implementation of the changes. The mean waiting times for GP referral to 1 st clinic (11, 13, 8 days); 1 st clinic to mpMRI (17, 5, 1 days); and 1 st clinic to biopsies (22, 18, 8 days) for pre-, during and post pathway implementation, respectively. Post-implementation 72% patients were reviewed the same day with mpMRI results and given a definitive plan: biopsy, PSA surveillance or discharge. Prompt mpMRI and same day review also allowed 28% of referrals to be discharged or put on PSA follow-up, constituting a "clock-stop" on their pathway. Pathway compliance on 62 day metric was near 100% on the new pathway. The total cost per MRI/biopsy patient is -£661 on the new pathway (2016 HRG codes); compared to the historical cohort this was at least cost neutral as it only involved efficient re-organisation of pre-existing practice. Conclusions: Providing and maintaining a robust and timely prostate cancer pathway catering to a large patient population is both feasible and rewarding. This requires a multi-disciplinary team approach without any additional funding at sites where mpMRI is already a part of the prostate diagnostic work up.