6709 Audit of GP 2 week wait referrals for suspected paediatric bone and soft tissue tumours to a tertiary referral centre in London

Objectives The Royal National Orthopaedic Hospital is a regional referral centre for suspected paediatric bone and soft tissue cancers from London and southeast of England. Referrals are seen by a paediatrician and discussed in an MDT with sarcoma surgeons/radiologist to decide on need for biopsy or further radiology to establish diagnosis. The aim of the audit was to evaluate the adherence to cancer pathway standards ¹ in terms of time seen (14 days), time to informing patient of diagnosis (28 days) and time to initiation of treatment of cancer (62 days) and to find out diagnoses of referred cases. Methods Retrospective analysis of electronic records from January 1, 2022, to December 31, 2022. All 2 Week Wait GP referrals for paediatric patients aged 1 to 16 years were included in the audit. Results 119 referred, 62 (52%) Male patients, commonest age: between 10–15 years. Commonest reason for referral was bone pain or lump. 26 referrals did not meet referral criteria and were rejected; commonest rejection reason was presenting complaint in head and neck or insufficient information. 93 patients were seen. 92 of these (99%) of these were assessed within two weeks. 8 (9%) of cases were diagnosed with cancer, 85 (91%) were benign conditions. 86 (92%) were informed of their diagnosis within 28 days. Amongst the 8-cancer diagnosis 3 were osteosarcoma, 1 Ewings, 1 myxoid liposarcoma, 1 alveolar rhabdomyosarcoma, 1 Beta lymphoblastic lymphoma, 1 Spindle cell sarcoma. Of these all had high suspicion of cancer radiologically. Of those diagnosed with cancer, 3 (37.5%) had treatment within 31 days and 6 (75%) initiated within 62 days. Reasons for delay in starting treatment include delay in diagnosis. Commonest benign condition seen was osteochondroma (25 case), 8 Osgood Schlatter, 7 Normal anatomical variants, 5 Vascular malformation, 4 Osteoid Osteomas, 4 Bone remodelling,3 pilomatrixoma, 30 other cases. Many of these benign conditions are referred for local or specialist care but some are followed up by specialist paediatric teams at RNOH. Conclusion Cancer pathway standards are being met for review within 2 weeks and informing patients of diagnosis, but further review is needed to understand delays in initiation of cancer treatment. 9% of seen referrals have a cancer diagnosis and these are limited to those with suspicious radiology. Most referrals (91%) are benign and further discussion is needed to streamline the pathway for these conditions. Reference National Cancer Waiting Times Monitoring Dataset Guidance, Version 11.1, April 2023.