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Formerly St Helens and Knowsley Teaching Hospitals NHS Trust

Non-Specific Symptoms (NSS)

Blue dividing line to split the page

Firstly, we would like to thank you for the increased use of our Non-specific symptom's pathway since its launch in Spring 2021.

NSS pathways are intended to cover the cohort of patients who do not fit clearly into a single ‘urgent cancer’ referral pathway, as defined by NG12, but who are nonetheless at risk of being diagnosed with cancer.

The cancer pick up rate for NSS referrals is 9% on average so we would like to encourage the ongoing referral of patients to this pathway.

Please take a moment to re-familiarise yourself with the NSS core referral criteria:

  • New unexplained, unexpected, or progressive pain, including bone pain, of 4 weeks or more.
  • GP ‘gut feeling’ of cancer diagnosis – reasons to be clearly described at referral.
  • Abnormal radiology suggesting cancer; not needing admission and not suitable for existing urgent cancer referral.
  • New unexplained constitutional symptoms of four weeks or more (less if very significant concern). Symptoms include loss of appetite, fatigue, nausea, malaise, bloating.
  • New unexplained vague abdominal pain of 4 weeks or more (less if very significant concern).
  • New unexplained and unintentional weight loss (either documented >5% in three months or with strong clinical suspicion).

Positive patient feedback

The patient was referred via 2WW due to unintentional weight loss, and abdomen pain. No previous cancer diagnosis, however, she had previously been investigated for cancer due to a family history of bowel cancer and was also referred to the Burney Breast Unit at STHK due to a skin nodule.

Investigations were completed whilst on the NSS pathway, which had not identified malignancy. The patient said the pathway from the beginning felt different. They had received a phone call from a nurse and were given a name, contact number and appointment details. Having a name to refer to made the first appointment easier. The patient expected to wait up to two weeks and was prepared for a long wait, but it wasn’t long at all.

Once the results had been explained to the patient, it became such a weight off her mind. The patient was worried about her blood results and during this time she couldn’t speak to her GP so having a point of contact really helped and reassured the patient.

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