Metastatic cancer of unknown primary (CUP) is a common, well-recognised yet heterogeneous clinical syndrome. Patients may be disadvantaged during their diagnostic workup because they fall outside established multidisciplinary team pathways.

The authors undertook an audit after introducing a CUP service in 2010 and compared it with a baseline audit to determine whether the new service improved the patient pathway. The baseline audit of medical records consisted of 45 consecutive patients referred to the Edinburgh Cancer Centre over six months in 2007. A repeat audit was performed in 2011 of the first 100 consecutive CUP patients.

After introducing the service, the mean number of days from secondary care review to oncology referral fell from 37 to 17 days, length of hospital stay from 12 to six days, number of blood tests from 16 to eight, and radiological investigations from four to three. Sixty six patients initially presented via inpatient admissions. Referral to palliative care increased from 60 per cent to 77 per cent. Based on these encouraging results, the authors hope to expand the service throughout Lothian.