Rectal, Esophageal, and Pancreatic Cancer Stacked Testing

Background: Our organization had the opportunity to reduce the time of discovery of suspicious mass to surgeon consultation for patients with rectal, esophageal, and pancreatic cancer.

Cancer patients undergo many tests that need to be completed for development of a treatment plan. Standard testing is often fragmented or incomplete, requires multiple preps, and can take 3 to 4 weeks. This leaves the patient with unanswered questions, valuable time wasted, poor patient satisfaction, increased anxiety levels, time off work, and another office visit to the surgeon. Our organization serves many rural areas, and patients travel from as far as 110 miles away. The ineffective testing process was highly frustrating to the patients, families, and the cancer care team.

Objective: To create a streamlined testing process in which newly diagnosed cancer patients can get all staging workup completed in 1 day prior to their consultation with the surgeon. This process improvement would expedite development of a treatment plan, ultimately decrease the time from diagnosis to the beginning of cancer treatment, and improve patient outcomes.

Methods: A Rapid Improvement Model project, led by nurse navigators, was used to create a streamlined process in which patient staging workup is completed in 1 day and discussion at our gastrointestinal (GI) cancer conference and a surgeon consultation occur within a 1-week period. With the new process, the patient is scheduled for stacked testing once a mass is discovered upon esophagogastroduodenoscopy (EGD), colonoscopy, or imaging. Stacked testing is done on Monday and Tuesday mornings, discussion at the GI cancer conference with the cancer team on Wednesday, and the patient is seen by the surgeon in the office. At that surgeon consultation, the surgeon has reviewed the case in cancer conference and can discuss with the patient and their family the cancer staging and treatment plan.

Results: This innovative and efficient process has shown a decrease in the length of time in the development of a treatment plan. For rectal cancer patients, from mass to surgeon consultation, the time decreased from 22 to 14 days. For esophageal cancer patients, from EGD to surgeon consultation, the time decreased from 25.35 to 14 days. For pancreatic cancer patients, from mass on imag-ing to surgeon consultation, the time decreased from 39.37 to 12 days. The process ensures that testing is completed per National Comprehensive Cancer Network guidelines, providing quality cancer care.

Conclusions: This innovative process has shown a decrease in the length of time in the development of a treatment plan and has improved patient and provider satisfaction and ultimately patient outcomes.