The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

Introduction: Cancer survival in England lags behind most European countries, due partly to lower rates of early stage diagnosis. We report the protocol for the evaluation of a multidisciplinary diagnostic centre based pathway for the investigation of ‘low risk but not no risk’ cancer symptoms called the Suspected CANcer (SCAN) pathway. SCAN is a new standard of care being implemented in
Oxfordshire; one of a number of pathways implemented during the second wave of the ACE programme, an initiative which aims to improve England’s cancer survival rates through establishing effective routes to early diagnosis.

Methods and analysis: To evaluate SCAN, we are collating a prospective database of patients referred onto the pathway by their GP. Patients aged over 40 years, with non-specific symptoms such as weight loss or fatigue, who do not meet urgent cancer referral criteria or for whom symptom causation remains unclear after investigation via other existing pathways, can be referred to SCAN.
SCAN provides rapid CT scanning, laboratory testing, and clinic review within 2 weeks. We will follow all patients in the primary and secondary care record for at least two years. The data will be used to understand the diagnostic yield of the SCAN pathway in the short term (28 days) and the long term (2 years). Routinely collected primary and secondary care data from patients not referred to SCAN
but with similar symptoms, will also be used to evaluate SCAN. We will map the routes to diagnosis for patients referred to SCAN to assess cost-effectiveness. Acceptability will be evaluated using patient and GP surveys.

Ethics and dissemination: The Oxford Joint Research Office Study Classification Group has judged this to be a service evaluation and so outside of research governance. The results of this project will be disseminated by peer reviewed publication and presentation at conferences.