P286 Earlier diagnosis of neuroendocrine tumours (NETs) through transformation of the South Wales NET service. (19th June 2022)

• Record Type: Journal Article
• Authors: Gould, Harriet; Amin, Kapish; Karategos, Thanos; Abbas, Sarah; Taylor, Rebecca; Cook, Katherine; Powell, Catherine; Hargest, Rachel; Phillips, Simon; Khan, Mohid
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A179
• Page End: A179
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.339
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Neuroendocrine tumours (NETs) are heterogeneous cancers, arising mainly from the gastroenteropancreatic tract. Delayed diagnosis and mislabelling are widely recognised internationally in midgut NETs with little data describing how to improve diagnosis times. In 2017, transformation of the South Wales NET Service included a change to a gastroenterology-led service model, alongside education and forming working relationships with gastroenterologists and surgeons. This study aims to evaluate whether this transformation had any impact on times and routes of diagnosis of GEP-NETs. Methods: This was a retrospective study of accurate hospital records for 224 patients with midgut NETs (and unknown primary, likely to be midgut). There were 110 patients pre-transformation and 114 post-transformation. Results: Median diagnosis time from symptom onset more than halved between the new and the old service, from 12.9 months to 5.3 months (p<0.05). Diagnostic delay over 3 years was 13% pre-transformation, 6% post-transformation. 40% of patients were mislabelled as IBS or other pre-transformation; reducing to 25% post-transformation. 25% were discharged from secondary care prior to re-referral and diagnosis; reducing to 19% after 2017. Across all years, 86.6% had at least one symptom at diagnosis; the most common was abdominal pain (57.6%), followed by diarrhoea (42.9%), weight loss (32.1%), flushing (19.2%), bloating (13.0%) and loss of appetite (8.0%). Patients were diagnosed on a variety of presentations. This is shown in the figure below: 46% of patients diagnosed on an emergency admission, had a background of chronic symptoms, for which nearly half (47%) were already being investigated prior to the emergency. 19.7% and 62.6% of all patients were diagnosed by gastroenterology and GI surgical specialities respectively. As a first line investigation 66.6% of patients had a CT, compared to 26.7% who had colonoscopy; CT suspected a NET in 49% of these patients, compared to 20% in colonoscopy. Overall, an abnormality was identified in 97% of CTs performed at any time in the lead up to patient diagnosis. Conclusion: Transformation of a central NET service towards a gastroenterology-led hub and spoke model has improved diagnosis times considerably and has led to earlier presentation with less metastatic disease. This is likely to be related to increased awareness of NETs amongst diagnosing gastroenterology and surgical specialties through education and engagement.