2.3 Initial referral
If the general practitioner confirms a cancer diagnosis or suspects a cancer diagnosis but cannot confirm it, they must refer the patient to a specialist (upper GI surgeon) with expertise in oesophagogastric cancer and who is an active participant in an upper GI MDM to progress management.
An upper GI cancer nurse coordinator should work with the surgeon to facilitate the referral and management process in specialist units.
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), 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 oesophagogastric cancer 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
- information about the severity of dysphagia and inability to maintain nutrition and hydration
- notification if an interpreter service is required.
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.
- Where there is a confirmed diagnosis or high level of suspicion, patients should see an upper GI surgeon within two weeks of referral.
- Imaging and work-up by the specialist can precede initial assessment but should not delay referral. The general practitioner or cancer care coordinator is critical in this process to ensure referral is not delayed.
- Urgent referral to allied health practitioners (particularly a dietitian) may also be required before an MDM.
