DIAGNOSIS OF TESTICULAR CANCER

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DIAGNOSIS OF TESTICULAR CANCER

• A Study to Examine Ultrasound Scans and Positive
  Testicular Cancer Patients.

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Project Group

• Urology Department Essex Rivers Healthcare
  Colchester in partnership with Mid Anglia Cancer
  Collaborative
• Donna Booton (Project Manager)
• Jacqueline Grice (Data Co-ordinator)
• John Corr (Lead Consultant)
• Martin Gould (Lead Radiologist)

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Problem

• 569 ultrasound scans of testes 1st April
  2000-Sept 30th 2001.
• 11 patients with a positive diagnosis.
• Assumption that the majority of the referrals
  arise from primary care.

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Incidence

• Predominately found in young men, with a modal
  age at diagnosis of about 30.
• Over 90 of men will be cured.
• Continuous rise in the incidence over the past
  few decades.

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Task

• Examine 6 months of ultrasound scan cards to
  check referrer, reason for scan, date of request
  and date of scan.
• Check and examine journey times of positive
  patients.
• Map poor patient journeys in order to identify
  delays.

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Results of scan requests

• 27.2 (155) scans read.
• Average wait 36 days.
• Age range 1-92 years.
• Median age 40.

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Referrers for ultrasound scans -of 155 examined

• No. of referrers
• Consultant 44
• Staff Grade 9
• SpR 24
• SHO 13
• HO 5
• GP 14
• Unknown 46

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Quotes from scan requests

• 1/12 history of increased size testicular
  swelling
• Pain from previous surgical exploration 10 years
  ago
• Single episode swollen left testicle, GP
  diagnosed hydrocele, nil present O/E
• 6/12 swelling
• Patient needs reassurance

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Our findings

• Cards not completed correctly.
• Some cards written clearly, the majority were
  illegible.
• No identification of requesting Doctor on some.
• 1 patient had 5 scans.
• 1 card had 3 different styles of handwriting in
  the reason for referral.

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Solutions

• Identify most timely /direct route for referrals
  and diagnostic processes.
• Reduce number of referrers.
• Write referral protocols for testicular
  ultrasound scans.
• Present to primary and secondary care
  stakeholders.

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References

• Dearnaley DP, Huddart RA and Horwich A (2001)
  Managing Testicular Cancer. BMJ Vol.322, pp
  1583-1588.
• NICE (2001) Improving Outcomes in Urological
  Cancers. Guidance on Cancer Services (Draft).
• NPAT (2001) Radiology Service Improvement Guide.