NICE guidance, but who does the work?

摘要

The latest clinical guidance from the National Institute for Health and Clinical Excellence (NICE), 'Diagnosis and management of metastatic malignant disease of unknown primary origin' [1], commissioned at the request of the Department of Health, was published in July 2010. The experiences of this group of patients come across very clearly in terms of personal testimony and poor outcomes, with survivals of 16% at 1 year and 8% at 5 years. Although cancer outcomes have been improving generally, the survival for cancer of unknown primary (CUP) has remained unchanged. CUP patients are more likely to present as emergency admissions and spend longer as inpatients, undergoing extensive and often fruitless investigations, than the general National Health Service population. In part this is due to their unusual mode of presentation, but largely due to a lack, of ownership by an appropriate multidisciplinary team (MDT) and the lack of access to specialist oncological and palliative care support.