Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Solving unknown primary cancer - earlier diagnosis (SUPER-ED): a stepped wedge cluster randomised controlled trial implementing a model of care to support earlier diagnosis. (#239)

Penelope Schofield 1 2 , Anna Ugalde 3 , Richard Tothill 4 , Steve Quinn 1 , Hui Li Wong 2 , Owen Prall 2 , Catherine Mitchell 2 , Nilmini Wickramasinghe 1 , Clare Fedele 5 , Louisa Gordon 6 , Sarah McLean 2 , Cindy Bryant 7 , Hyun Ko 2 4 , Tim Akhurst 2 , Colin Wood 2 , Desmond Yip 8 , Christopher Steer 9 , Bo Gao 10 11 , Nicholas Wilcken 10 12 , Narayan Karanth 13 , Anna Kuchel 14 15 , Chris S Karapetis 16 17 , Louise Nott 18 , Shamsudheen Padinharakam 19 , Ian M Collins 3 20 , Madhu Singh 21 , Mark Shackleton 22 , Mark Warren 23 , Rachel Wong 24 25 , Zee Wan Wong 26 27 , Natalie Richards 2 , Elizabeth Todio 2 , Alexis Butler 2 , Tharani Sivakumaran 2 4 , Linda Mileshkin 2 4
  1. Swinburne University, Hawthorn, Vic
  2. Peter MacCallum Cancer Centre, Melbourne, Australia
  3. Deakin University, Burwood, Vic
  4. University of Melbourne, Parkville, Vic
  5. CSL, Melbourne, VIC
  6. QIMR Berghofer, Brisbane, Qld
  7. Carer, Peter MacCallum Cancer Centre, Melbourne, VIC
  8. Canberra Hospital, Canberra, ACT
  9. Border Medical Oncology, Albury, NSW
  10. University of Sydney, Sydney, New South Wales, Australia
  11. Westmead Hospital , Sydney, NSW
  12. Westmead Hospital, Sydney, NSW
  13. Royal Darwin Hospital, Darwin, NT
  14. Royal Brisbane Women’s Hospital , Brisbane, QLD
  15. University of Queensland, Brisbane, QLD
  16. Flinders Medical Centre, Adelaide, SA
  17. Flinders University, Adelaide, SA
  18. Royal Hobart Hospital, Hobary, TAS
  19. Launceston General Hospital, Launceston, TAS
  20. Southwest Healthcare, Warrnambool, VIC
  21. Barwon Health, Geelong, VIC
  22. Alfred Health, Melbourne, VIC
  23. Bendigo Health, Bendigo, VIC
  24. Eastern Health, Melbourne, Vic
  25. Monash Health, Melbourne, Vic
  26. Monash University, Clayton, VIC
  27. Peninsula Health, Frankston, VIC

Background and Aims

Cancer of unknown primary encompasses a diverse range of cancer types, whereby a metastatic lesion(s) is identified but a primary tumour evades clinical detection. Not all patients with cancer of unknown primary in Australia receive a standardised workup and this may lead to prolonged time to diagnosis and poor patient experience. This trial, titled Solving Unknown Primary Cancer - Earlier Diagnosis (SUPER-ED), aims to 1) standardise a Model of Care that adopts a standardised diagnostic workup adapted from the Optimal Care Pathways, with an embedded care coordinator, access to a virtual, national multidisciplinary meeting and an educational website and 2) implement this new Model of Care across a network of oncology services. This trial is funded from the Medical Research Future Fund.

Method

This is a stepped-wedge cluster randomised trial comparing a control phase (standard practice) with an intervention phase. Fifteen sites will be grouped into three health service clusters. People who present with a malignancy of unknown origin, are over 18, are clinically appropriate to undergo diagnostic workup and able to consent will be eligible to participate. A total of 288 patients will be enrolled.

The intervention is the new Model of Care and the primary endpoint is the time to completion of minimum diagnostic workup. Secondary endpoints include: the primary tumour type diagnosed, clinical trial participation rates, patient-reported physical, social and mental health, uncertainty and understanding. The implementation of the Model of Care will be assessed for acceptability, adoption, feasibility and fidelity through semi-structured clinician interviews, engagement with the nurse coordinator, diagnostic workup and website analytics.

Progress

Ethical review is underway. This is a four year study and the recruitment period is August 2023 – March 2026.