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Table 2 Example pathway 2 (Male, age 23 years at diagnosis of Hodgkin’s lymphoma) and explanatory narrative

From: Achieving a timely diagnosis for teenagers and young adults with cancer: the ACE “too young to get cancer?” study

  1. History: Presented to a local emergency department with a 6 week history of feeling unwell, with cough, evolving cervical lymphadenopathy and recent onset of night sweats. He had had no prior contact with primary care and was living away from home at the time
  2. Pathway: Patient was admitted from the emergency department, radiology and blood tests taken and a biopsy was performed the following day which confirmed Hodgkin’s Lymphoma. The patient elected to return home for treatment. His GP was informed on Day 4 and a referral made to his local hospital where he was seen as an outpatient for reassessment and completion of staging investigations on Day 15. The diagnosis and treatment plan were discussed at the local MDT on Day 21 and chemotherapy commenced on Day 35 after further discussion with the patient and insertion of a PICC line
  3. Intervals:
  4. Primary care interval (1st seen to 1st referral) = Not applicable
  5. Secondary care interval (1st referral to start of treatment) = 34 days
  6. Diagnostic interval (1st seen to diagnosis (date of biopsy)) = 2 days
  7. Treatment interval (Diagnosis (date of biopsy) to start of treatment) = 33 days
  8. Key points arising in the panel discussion:
  9. 1. This patient presented as an emergency and was diagnosed without delay. The time taken to commence treatment was longer than might otherwise have been necessary only because he was living away from home and elected to be referred back to his local hospital for completion of staging, treatment planning and treatment
  10. “Clinical bottom line” decision: Best practice