In England, when people present in primary care with non-specific or vague symptoms that may be indicative of cancer, such as fatigue or unintentional weight loss, they often face significant delays to diagnosis.1 They are often referred to multiple specialists before cancer is ruled out or diagnosed. A hospital trust in London launched an advanced diagnostic oncology clinic, where people with such symptoms can be seen by a multidisciplinary team within 5 days of referral from a GP.2 3 The team reviews the person’s medical history and consults with specialist oncologists or radiologists, where necessary, to reach a diagnosis as quickly as possible.



Cancer survival rates in the UK have doubled in the past 40 years, but they still lag behind rates in other high-income countries, such as Australia, Canada, Norway and Ireland.4 Survival rates also vary considerably based on cancer type; for example, 85% of people diagnosed with breast cancer will survive for five years or more, but this figure drops to under 7% for people with pancreatic cancer.5

Late diagnosis can lower survival rates and worsen outcomes for people with many types of cancer.5 People with vague and non-site-specific symptoms, such as fatigue or unexplained weight loss, are more likely to be diagnosed at an advanced stage and in an emergency department.1

General practitioners (GPs) may  struggle to access vital diagnostic tests if symptoms do not meet the criteria for dedicated cancer diagnostic pathways, thus preventing a timely referral for diagnosis. 1 People may be referred to several specialists in succession and sent back to their GP each time a diagnosis is ruled out, further delaying diagnosis.1 3



In 2015, staff at Chelsea and Westminster Hospital NHS Foundation Trust in London launched an acute diagnostic oncology clinic (ADOC).6 The service is run by an oncologist-led multidisciplinary team, which includes oncology nurses, GPs with a special interest in cancer and a pathway coordinator.2

GPs can refer adults presenting vague symptoms that may be indicative of cancer to the ADOC, if they are not eligible for other diagnostic pathways or are too unwell to wait to see a specialist .1 2 GP referrals to the ADOC are reviewed and approved by a specialist nurse who works in the clinic.3 The service aims to rule out or diagnose cancer within 7–18 days.1 2

People are booked in for an outpatient appointment with a GP with a special interest in cancer, who assesses their medical history, orders diagnostic tests, and consults with oncologists and radiologists to establish a diagnosis.2 3 As the ADOC is based in a large hospital, people can also receive additional tests from other departments after their first consultation.3

People diagnosed with cancer in the ADOC are referred directly to a multidisciplinary care team.1 3 If cancer is ruled out, but another serious condition is suspected, they are then referred to a relevant specialist to prevent further delays to their diagnosis and reduce pressures on primary care.


What has been achieved?

As of December 2021, 5% of all GP referrals for suspected cancer made within the area covered by the Trust go through the ADOC.3

Between February and April 2021:

  • every person who received a cancer diagnosis was referred to an oncologist within two weeks of starting to use the ADOC
  • cancer was diagnosed or ruled out within 28 days of referral to the ADOC in more than 70% of people
  • 83% of people referred rated the service as excellent.1

GPs have also reported that the ADOCs have:

  • reduced the number of people who are returned to primary care without a diagnosis following referral to a specialist
  • shortened diagnostic delays for cancer and other conditions
  • provided people with a better, more personalised diagnostic experience
  • prevented people from attending emergency departments because of their symptoms.7

The Chelsea and Westminster Hospital NHS Foundation Trust has been recognised as a best practice example for non-site specific rapid diagnostic oncology centres. As a result the ADOC model has been scaled-up beyond the Trust, serving more people across a wider area of London.1 3


In addition, a 2021 evaluation found that the NHS trust’s costs were reduced when people with vague symptoms were referred to the ADOCs instead of other diagnostic pathways.3 7


Next steps

In late 2021, the service secured funding from Health Education England to hire and train a newly qualified GP, who is interested in developing their knowledge and understanding  of cancer.3


Further information

  • The ADOC page on the Chelsea and Westminster Hospital NHS Foundation Trust website



Dr Abhijit Singh Gill, GP with a Special Interest in Oncology, Acute Diagnostic Oncology Clinic, Chelsea and Westminster Hospital NHS Foundation Trust  –


  1. Gill AS. 2021. Acute Diagnostic Oncology Clinic and RDCs. Westminster Forum - Priorities for cancer care; 30/09/21; Online [accessed: September 2021]
  2. helsea and Westminster Hospital NHS Foundation Trust. 2021. Acute Diagnostic Oncology Clinic (ADOC). Available here: [accessed: November 2021]
  3. Gill A. 2021. Interview with Catherine Hodge at The Health Policy Partnership [video call]. 07/12/21 [accessed: December 2021]
  4. Cancer Research UK. 2017. Cancer treatment statistics. [Updated 01/09/17]. Available here: [accessed: July 2021]
  5. Cancer research UK. 2021. Cancer survival statistics. Available here:,40%20years%20in%20the%20UK [accessed: November 2021]
  6. Evans R. 2019. GP leads innovative cancer diagnostic service. [Updated 05/06/21]. Available here: [accessed: November 2021]
  7. RM Partners: West London Cancer Alliance. 2021. Rapid diagnostic centres for non-site-specific cancer symptoms. London: RM Partners: West London Cancer Alliance