If the cancer diagnosis is confirmed or the results are inconsistent or indeterminate, the general practitioner must refer the patient to a specialist physician to make the diagnosis.

It is important to consider the patient’s overall health, including comorbidities and frailty. In certain circumstances if MDS is suspected and patients have mild cytopenias and significant comorbidities, they may be safely monitored by the general practitioner.

Patients should be enabled to make informed decisions about their choice of specialist and health service. General practitioners should make referrals in consultation with the patient after considering the clinical care needed, cost implications (see referral options and informed financial consent on page 9), waiting periods, location and facilities, including discussing the patient’s preference for health care through the public or the private system.

Referral for suspected or diagnosed MDS should include the following essential information to accurately triage and categorise the level of clinical urgency:

• important psychosocial history and relevant medical history
• family history, current symptoms, medications and allergies
• results of current clinical investigations (imaging and pathology reports)
• results of all prior relevant investigations
• notification if an interpreter service is required.

The following clinical prioritisation criteria are used to triage patients with MDS. Urgent referral should occur within two weeks of initial work-up.
Any of the following indicators requires urgent referral:

• severity of cytopenias – neutrophils < 0.5 × 10^9/L or neutrophils > 0.5 and recurrent infections needing antibiotics
• platelets < 30 × 10^9/L or bleeding symptoms even if platelets are above threshold
• symptomatic unexplained anaemia or haemoglobin < 80 g/L.

Many services will reject incomplete referrals, so it is important that referrals comply with all relevant health service criteria.
If access is via online referral, a lack of a hard copy should not delay referral.

The specialist should provide timely communication to the general practitioner about the consultation and should notify the general practitioner if the patient does not attend appointments.

Aboriginal and Torres Strait Islander patients will need a culturally appropriate referral. To view the optimal care pathway for Aboriginal and Torres Strait Islander people and the corresponding quick reference guide, visit the Cancer Australia website.

Download the consumer resources – Checking for cancer and Cancer from the Cancer Australia website.
For Aboriginal-led health information and services visit the NACCHO website.