Evaluating the effectiveness of new Rapid Diagnostic Cancer Services (RCDS) in Scotland
We love to support our education users in their projects and were delighted to hear from Nathan Thompson from the University of Strathclyde, on how he is using Simul8 to evaluate the effectiveness of Rapid Diagnostic Cancer Services (RCDS).
Given the healthcare crisis across the world, with massive backlogs and patients not receiving their cancer diagnosis in a timely manner, topical projects like RCDS are a great step in creating efficient processes so patients get better treatment, at the right time. So, we were excited to find out more from Nathan.
Nathan, can you tell us more about your project?
Of course. Today, many less common or harder to detect cancers are not being picked up by site-specific cancer pathways due to patients commonly presenting with vague symptoms. So, the University of Strathclyde are currently evaluating effectiveness of the new Rapid Diagnostic Cancer Services (RCDS) that are being piloted in Scotland.
The pathways have been created and trialed within three NHS boards in Scotland (Dumfries & Galloway, Fife and Ayrshire & Arran) and offer primary care clinicians an accelerated route for cancer diagnostics for patients presenting with non-specific symptoms where the clinician has a suspicion of cancer. Each pathway varies slightly for the 3 sites, so we needed to develop 3 models which take into consideration the different site-specific requirements, including staffing arrangements and diagnostics availability.
The pathways are based on designs that have become popular in England, Wales and Denmark over recent years and have proved to be effective in providing accelerated patient diagnosis with cancer incidence rates found to be comparable to site-specific cancer pathways and high levels of patient and professional satisfaction.
What is the aim of your project?
Our aim is to conduct a health economic analysis of the pathways to aid future decision making. The purpose of the work we are doing at the University of Strathclyde is really to inform decisions such that the pathways can run in a sustainable manner going forward, whilst also highlighting areas where greater optimality could potentially be achieved.
We also want to prove that it will be effective in diagnosing patients as early as reasonably practical. If you detect symptoms early on in patients, they can receive the treatment they need significantly faster.
How did the University of Strathclyde end up working on this project?
The University of Strathclyde have a department of Management of Science, who over the years have worked on many healthcare projects. With cancer being so prevalent and backlogs and waiting times being such a massive issue in healthcare, projects relating to cancer are gaining momentum. Our project team also includes cancer specialists from the Digital Health and Care team at the University of Strathclyde, who have specialist knowledge, which has been incredibly useful for our RCDS project.
What are the vague symptoms that the pathways are looking for?
That’s a great question. One of the main symptoms the pathways will be looking for is unexplained weight loss. But other symptoms include unexplained fatigue, pains, particularly abdominal pains and GP suspicion of cancer.
If a GP has a suspicion that they want to refer a patient onto this pathway, they have access to a suite of direct-access diagnostics, typically various blood and urine tests. Results from which can be used to assist with pathway vetting and patient redirecting. Pathways differ in the GP direct-access tests and exact pathway structure. Additional diagnostics, along with corresponding diagnostic specialists, are available to those accepted onto the pathway, with imaging diagnostics playing a key role.
Why would a patient be re-directed from the pathway?
Initially, around 85-90% get accepted onto the pathway and 10-15% are redirected to more suitable services during pathway triage/vetting provided there is confidence that the presenting symptoms are not believed to be due to cancer – which is a high percentage of people being accepted onto the pathway. However, once they are accepted, additional diagnostics are carried out, such a CT scans, biopsies etc in order to come to an outcome as quickly as possible.
From referral, patients receive an RCDS outcome within 7 days or 21 days (depending on the model used by health board). So, these pathways will really help with the backlog hospitals are facing by reducing waiting times.
How does Simul8 play a part in your project?
Simul8 has allowed us excellent flexibility to model the real-life processes of the pathways. At the University of Strathclyde, Simul8 is popular among students and researchers when carrying out health economic analysis. For this project, using Simul8 meant we can model pathway activities, with associated costs and resources and easily track these whilst also allowing for realistic variability and decision rules. By modelling the pathways and making relevant comparison, we can greatly assist future decisions around budgeting and pathway optimization.
How do you measure the value of the project?
If it has successfully aided in helping to make the decisions that need to be made! Small alterations to processes can make massive differences to a patient’s diagnosis, treatment and hospital journey and it’s important that this is handled as smoothly as possible. If we see a more productive process that is sustainable in accelerating cancer diagnosis and improving patient/professional experience, then we know this project has great value.
What does working on the project mean to you?
It’s been amazing to be involved in something which will make a difference to so many lives, by people getting the treatment they need early on. So many people have been affected by cancer or lost loved ones to it, so it was very rewarding and fulfilling to work on a project that will massively help people.
It’s an exciting time to be working in healthcare. We need clever solutions to ensure processes work as efficiently as possible, and to identify areas where investment is important so that people get the treatment they need, which is what RCDS is aiming to do with the help of simulation.