Six-year experience of Australia’s first dedicated cancer of unknown primary clinic

Background Diagnosis and management of cancers of unknown primary (CUP) remain challenging. This study examines the referral patterns, management and outcomes of patients referred to Australia’s first dedicated CUP clinic. Methods Retrospective medical record review was conducted for patients seen a...

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Bibliographic Details
Published in:British journal of cancer 2023-08, Vol.129 (2), p.301-308
Main Authors: van Mourik, Arielle, Tonkin-Hill, Gina, O’Farrell, John, Waller, Shohei, Tan, Lavinia, Tothill, Richard W., Bowtell, David, Fox, Stephen, Fellowes, Andrew, Fedele, Clare, Schofield, Penelope, Sivakumaran, Tharani, Wong, Hui-Li, Mileshkin, Linda
Format: Article
Language:English
Subjects:
692/4028/67/1680
692/4028/67/69
Australia - epidemiology
Biomedical and Life Sciences
Biomedicine
Cancer
Cancer Research
Cancer therapies
Chemotherapy
Clinical outcomes
Clinics
Diagnosis
Drug Resistance
Epidemiology
Gene Expression Profiling
Genomics
Health care delivery
Humans
Immunotherapy
Malignancy
Medical diagnosis
Medical referrals
Molecular Medicine
Neoplasms, Unknown Primary - diagnosis
Neoplasms, Unknown Primary - genetics
Neoplasms, Unknown Primary - therapy
Oncology
Patients
Retrospective Studies
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Summary:Background Diagnosis and management of cancers of unknown primary (CUP) remain challenging. This study examines the referral patterns, management and outcomes of patients referred to Australia’s first dedicated CUP clinic. Methods Retrospective medical record review was conducted for patients seen at the Peter MacCallum Cancer Centre CUP clinic between July 2014 and August 2020. Overall survival (OS) was analysed for patients with a CUP diagnosis where treatment information was available. Results Of 361 patients referred, fewer than half had completed diagnostic work-up at the time of referral. A diagnosis of CUP was established in 137 (38%), malignancy other than CUP in 177 (49%) and benign pathology in 36 (10%) patients. Genomic testing was successfully completed in 62% of patients with initial provisional CUP and impacted management in 32% by identifying a tissue of origin or actionable genomic alteration. The use of site-specific, targeted therapy or immunotherapy was independently associated with longer OS compared to empirical chemotherapy. Conclusion Our specialised CUP clinic facilitated diagnostic work-up among patients with suspected malignancy and provided access to genomic testing and clinical trials for patients with a CUP diagnosis, all of which are important to improve outcomes in this patient population.
ISSN:0007-0920
1532-1827
DOI:10.1038/s41416-023-02254-6