The role of tumour marker testing in early diagnosis

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Published: 10 Sep 2017
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Dr Craig Barrington - South West Wales Cancer Centre, UK

Dr Barrington speaks with ecancer at ESMO 2017 about perspectives from his local tumour board, where he describes a large number of repeated tumour marker tests conduct resulting in little clinical significance.

He describes the economic benefit of testing requests being made in adherence to NICE guidelines, and questions how appropriate repeated testing is considering the delay in care and risk to patient well-being, when no clinically actionable information may be available.

Dr Barrington encourages appropriate use of tumour marker screening where available, and that cost and benefit be considered more closely.

ecancer's filming has been kindly supported by Amgen through the ECMS Foundation. ecancer is editorially independent and there is no influence over content.

 

My poster was looking at tumour markers in the diagnostic setting, specifically looking at patients who present with a cancer of unknown primary and whether the tumour marker is beneficial or not in the diagnostic setting. We showed that within our local health board many tumour markers were requested, not always following the guidelines that are out there through NICE. It’s very costly to the health board so the idea was to investigate that and what we’ve done now is we’re looking at stopping multiple tumour marker requesting, so multiple being more than two tumour markers within a two week period for any individual patient when they’re searching for a cancer diagnosis.

When you say many requests, how many are we talking about?

In a six month period there were over 17,000 tumour marker requests; specifically multiple requests, as I stipulated, there were just short of 2,000 in a six month period. Of those there were only just short of 300 patients actually diagnosed with cancer and only 35 where the tumour marker was actually used appropriately in the diagnostic setting. So a lot of requests but perhaps we don’t need to do that many really.

You mentioned that a lot of these might not be necessary or appropriate by NICE guidelines. How well do you think the guidelines are being communicated or available considering this?

NICE guidelines are very accessible but there’s definitely room for more education in this particular area which we’ve done locally through the Acute Oncology Service which is a new service established within the health board within the last couple of years. So we have done some education and the plan is to try and follow that up now by repeating the work that we’ve done, just to see if there’s any further education that’s needed. But I suspect there’s going to be more education needed.

You mentioned that they were costly, has any number been put to the exact economic cost of all these unnecessary screens?

Yes, we extrapolated it to twelve months and it’s just over £95,000 costs for the amount that have been done. So obviously if we are able to stop them that’s a significant saving. The challenge with it, of course, is we just looked at the tumour marker, we haven’t then looked at the subsequent investigations that have come from that tumour marker test - further radiological investigations, for example, other biochemical investigations, potential in-patient stay. It’s fairly exponential with regards to the cost for the health board.

There’s also the… I’ve heard a term ‘scanxiety’ that patients may experience if they are told ‘Oh, we’re doing extra tests about the cancer that you might have.’

Yes, very much so. Very much so. Tumour markers can guide physicians down the wrong route and cause that unnecessary anxiety for the patients and their families. So, yes, hopefully we’re able to, as I mentioned, educate to try and stop that. We’ve also recently set up a diagnostic centre within the health board and again given more education about that resource so physicians are able to refer the patient into that and then hopefully the most appropriate investigation is going to be done trying to ease that anxiety and obviously saving money again.

If there was a take home message for anyone on their health boards watching this at home today what would it be?

The take home message is tumour markers are beneficial in certain cases for diagnosis but they just have to be used in the appropriate way. If a patient sat in front of you you’re suspicious of cancer contacting the local acute oncology service for support is probably the best way to go forward.