PP24. ‘FIND OUT FASTER’: THE APPLICATION OF NEW CANCER PATHWAY STANDARDS TO PATIENTS REFERRED WITH SUSPECTED DIAGNOSIS OF MENINGIOMA
Authors: Ms Sarah Hawksby, Mr Jake Weddell, Prof Philip Kane
Journal: Neuro-Oncology (2017)

INTRODUCTION: The Improving Outcomes Guidance for patients with Brain & CNS tumours differs from other tumour sites in that it provides standards for the management of patients with benign tumours. Recently, the Department of Health has proposed new ‘Find out faster’ targets for cancer waiting times which aim to reduce the time between referral with a suspected malignancy and the communication of a definitive diagnosis. The new targets are: • 50% of patients to receive communication of a definitive diagnosis within 14 days. • 95% of patients to receive communication of a definitive diagnosis within 28 days. Can these targets be met for patients referred with a suspected diagnosis of benign meningioma? METHOD: Retrospective audit of the pathways of 50 consecutive patients referred to our Brain & CNS tumours MDT with a suspected diagnosis of meningioma between 13/02/2015 and 26/12/2015. Data was validated from MDT records, e-CAMIS, PACS and Specialist Nurse records. RESULTS: Complete data was available for 46 patients: 4 patients were excluded due to incomplete data. All patients had a radiological diagnosis of a meningioma at the MDT meeting. 43.48% (20/46) patients received a radiological diagnosis within 14 days and 65.22% (30/46) within 28 days. Thus 34.78% (16/46) were seen after 28 days (range: 29 to 205 days). Communication of diagnosis was through a letter to the GP or another medical specialty (5/46) or at outpatient review (41/46). 7 of the 46 patients underwent craniotomy and excision of tumour (range: 2 to 109 days after referral; 3 within 14 days, 1 within 28 days.) Only 1 patient (14.29%) received a histological diagnosis by day 28; the remainder received their diagnoses between day 35 - 140. All resected tumours were meningioma, WHO Grade 1. The main delay from referral to diagnosis for radiological diagnosis was clinic appointment availability; one patient cancelled their scheduled appointment several times (205 days from referral to radiological diagnosis) and there were no documented reasons for any other cause of delay. For histological diagnosis, it was the time from surgery to clinic appointment. CONCLUSION: Historically the application of “targets” for treatment times in the management of tumours has only related to cancer. The inclusion of meningiomas, the majority which are benign in nature, within the Improving Outcomes Guidance for brain and CNS tumours recognises that they can give rise to significant neurological, cognitive and psychological symptoms similar to those caused by malignant tumours. However, at present no “targets” exist for the management of benign intracranial tumours. The application of the “finding out faster” targets to the meningioma pathway gives insight to the relative slow pace of management of his tumour group. It also raises concerns regarding the definitions used in “finding out faster” such as date of referral and whether communicating a radiological diagnosis is adequate to achieve the target. We would argue that the development and introduction of targets for treatment time in benign intracranial tumour should be introduced.