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REMEDY : BNSSG referral pathways & Joint Formulary

Non-Specific Symptoms - 2WW

Checked: 04-03-2022 by vicky.ryan Next Review: 03-03-2023

Service overview

The Non Specific Symptom Pathway Pilot is due to be launched on Monday 7th March 2022. This is for patients with “vague symptoms” who do not meet the criteria for the existing suspected cancer pathways.

It is well recognised that there are a cohort of patients with symptoms that indicate they have a significant chance of having cancer but until now there has been no 2WW pathway to arrange investigation and assessment in a timely manner. 

The BNSSG Non-Specific Symptoms (NSS) is a new cancer referral pathway for patients in whom there is concern about cancer, but whose symptoms do not fit other site-specific NG12 (fast track) referral criteria.

The NSS service is based at the Bristol Haematology and Oncology centre but is working in partnership with primary care and the acute trusts in BNSSG to provide timely access to appropriate investigations to assess patients with concerning non-specific symptoms. These investigations will, whenever possible, take place in a hospital local to the patient.

Patients with evidence of metastatic cancer without a known primary should continue to be referred to the Cancer of Unknown Primary service.

Referral criteria and the mandatory filter tests

  • There is no other urgent referral pathway suitable for this clinical scenario
  • Unexplained weight loss
  • Patient reports severe unexplained fatigue
  • Persistent nausea or appetite loss
  • New atypical pain (eg. diffuse abdominal pain or bone pain)
  • Unexplained laboratory test findings (eg. anaemia, thrombocytosis, hypercalcemia)
  • Ongoing symptoms despite one negative 2ww referral

Please see the referral form for the Filter Function test results which are required before referral, as these may suggest another diagnosis/referral pathway.

Referral guidance

Refer via eRS to UHBW using the referral for Non-specific symptoms 2WW referral form

Please note, investigations will, whenever possible, take place in a hospital local to the patient.

The completed referral proforma should contain the results of all the mandatory filter tests, and a detailed reason for referral. It is vital that the filter tests are completed and reviewed prior to referral as these may demonstrate and alternative and more appropriate onward referral route. If filter tests are outstanding the NSS service may return the referral. Please ensure that the filter function tests are recent (less than six months old or less) and that clinical information is given to detail your concerns.

The filter tests have been agreed by the BNSSG NSS working group and are based on nationally mandate NSS filter tests.