EP.WE.1026Pathways to the Upper GI MDT; an evaluation of the factors influencing patient routes to diagnosis of oesphago-gastric cancer

Aims To review the characteristics of the patient group referred to Barts Health with Oesphago-gastric (OG) Cancer in one year (2018-19). To evaluate demographic trends in patients presenting as emergency referrals and the effect of language on patients’ pathway to diagnosis. Methods We collated a list of patients referred to the Upper GI MDT with OG cancer in one year (2018-2019). We collected relevant pre-determined data points from the trust electronic record system. Patients with missing or insufficient data were excluded. Results Our population of 125 patients (median age 69) included 51% White British, 11% Bangladeshi, 10% Afro-Caribbean and 4% Pakistani; proportions which are significantly different to that of the UK average (p < 0.002). 46% of patients presented by GP 2WW referrals and 32% emergency referrals. The 29% of the population that did not have English as a first language were not shown to be more likely to present acutely (p = 0.49). 18.7% of patients had more than 62 days between referral and MDT discussion; themes of delay were inappropriate referral type, histology delay and atypical presentation. Conclusions Our OG cancer population has a significantly different ethnic makeup compared to UK average. Our data shows higher acute presentations and lower GP 2WW referrals. We did not demonstrate that language as a single parameter was linked to acute presentation. A number of modifiable delays to diagnosis were identified particularly the need for repeat biopsies. Further analysis is required using more sophisticated socio-economic parameters to assess how ethnicity can influence presentation of OG cancer.

Radiological Correlation of Negative Appendectomies: A Clinical Audit

Introduction: Appendectomy is the most common surgical emergency and negative appendectomy is a one of recognized consequence of appendectomy. Recently an increased use of radiology is seen in diagnosing appendicitis and it has significantly decreased the rate of negative appendectomy. Every effort should be made to establish an exact diagnosis. If, however, this is impossible and a suspicion of appendicitis exists, exploration is mandatory. It is far better to subject a moderate number of patients to a theoretically unnecessary operation than to let one patient suffer perforation. Aim: Recently we have seen an increased use of radiology in our department for diagnosing appendicitis. The idea of conducting this audit was to calculate our negative appendectomy rate by correlating it with use of radiology and to compare it with international figures and to set up guidelines for use of radiology in diagnosing appendicitis on basis of results of our audit. Methods: Records of all patients who underwent appendectomy in Dubai Hospital, UAE from Jan 2018 to Jan 2019 were retrospectively analysed using electronic record system. Clinical diagnosis and radiological findings were compared with histopathology as gold standard for negative appendectomy rate. The sensitivity and specificity of different radiological procedures was calculated as well. Results: Total 165 patients underwent appendectomy in specified duration. Overall negative appendectomy rate was 17% with male being 9.7% and female rate 31%. CT scan was found to be 100% specific and 91.4% sensitive in diagnosing appendicitis while clinical diagnosis was accurate in 88.5% cases.

Impact of Telemedicine Tools on Record Keeping and Compliance in Haemophilia Care

Background Record keeping is integral to home treatment for haemophilia. Issues with paper diaries include questionable compliance, data validity and quality. Implementation of electronic diaries (e-diaries) in haemophilia patients could improve documentation of home treatment. Aim This article evaluates the effects of an e-diary, Haemoassist, on recording and patient compliance with therapy. Patients and Methods An explorative study was used to assess the sequential use of paper diaries and e-diaries by 99 patients with severe haemophilia A or B and 1 with severe factor VII deficiency. Median age was 41 years. Information was obtained from paper records for 3 years preceding the introduction of an electronic record system and the first 6 to 12 months of Haemoassist use. Data from the 3-year period were averaged. Missing data for rounded 12 months of e-diary use were extrapolated to correspond to a full year. Results Enhancement of 23% in record delivery was observed for the period of Haemoassist use (p = 0.013). Twenty-one percent increase in patients’ compliance for data reporting (from 65% 35 to 86% 22, p = 0.003) and 16% increase for documentation of bleedings (from 68 to 84% of patients, p = 0.01) were detected. Compliance to prescribed therapy of patients for the whole studied period improved by 6% (from 82% ± 29 to 88% ± 25, p = 0.05). Major advances were demonstrated predominantly in the age groups of between 13 and 20 and 21 and 40 years. Conclusion e-Diaries' use enables improved recording of information about patients' home treatment and bleeding episodes. Enhanced compliance with therapy may be a further benefit.

Sunitinib-associated hypothyroidism in patients with metastatic renal cell carcinoma.

443 Background: Sunitinib (sun) treatment for patients (pts) with metastatic renal cancer (mRCC) can often lead to fatigue. The incidence of sun-induced hypothyroidism (HT) in the phase III pivotal study of pts with mRCC was 14% for all grades and 2% for grades 3-4. Subsequent retrospective and prospective studies described incidences of between 30–85%. Elevated TSH alone may be seen in up to 85% of mRCC pts treated with sun. Symptoms of HT, eg: fatigue, constipation, cold intolerance, hair thinning, and dry skin have been reported in the majority of sun-treated pts. Methods: We reviewed of all cases of mRCC pts initiating sun treatment between January 2008 and December 2009 using the electronic record system Patient Pathway Manager. Pts with underlying HT, abnormal TFTs at baseline or those on sun for less than two cycles were excluded. TFTs were performed at baseline and then day 1 of every two cycles. Response was assessed every 2-3 cycles. The aims of the study were to Identify rate of sun-induced HT in St James’s Institute of Oncology and determine whether there is a correlation between HT and disease response. Results: 84 pts were included (median age 62 years). 90% had good or intermediate prognosis disease by Memorial Sloane-Kettering Cancer Centre (MSKCC) criteria. 52 pts had TSH <6mU/L and 32 had TSH of >6mU/L. Progression-free survival was significantly longer in those pts with TSH of >6mU/L (29.6 months) compared to those with TSH <6mU/L (11.3 months). Conclusions: Sun-induced HT occurred in approximately 30% of pts and predicted for improved progression-free survival. Further studies are needed to characterise this and updated data will be presented.