102 A service evaluation for the introduction of a malignancy of unknown origin pathway with a palliative care physician as the lead clinician

<h3>Introduction</h3> Malignancy of unknown origin (MUO) is cancer identified on limited tests and the primary site cannot be identified. A cancer of unknown primary (CUP) is cancer with an unidentifiable primary site after extensive investigations including histology. These patients have a poor prognosis. The Sheffield Teaching Hospitals MUO service was recently set up (May 2023) with a palliative medicine consultant as the lead. We carried out a service evaluation pre and post service initiation to look at how this has impacted the patient journey. <h3>Methods</h3> We looked at data for patients who had a final ICD10 code as a MUO or CUP. This included a total of 52 patients (26 pre- and 26 post- service set up). This is not reflective of the total number of patients who were seen in the service. Data was collected using online and paper documentation. Data was collected on symptom burden at presentation, number of biopsies performed and palliative care involvement. <h3>Results</h3> The average time from initial scan to death for patients (n=47) was 73 days (5 alive). Patients presented with a high symptom burden with only 3/52 patients being asymptomatic. The commonest symptoms were pain, weight loss and nausea. The number of patients who had a biopsy reduced from 54% to 24% with fewer patients referred to oncology. In deceased symptomatic patients, the average time being seen by palliative care from the initial scan reduced from 68 to 8 days. <h3>Conclusions</h3> Patients often present with a high symptom burden and have a poor prognosis. Early palliative medicine is key and leads to expert symptom management. Fewer biopsies were performed due a more holistic overview and assessment of the patient functional status allowing informed decisions with patients as to the risks and benefits of undergoing a biopsy.