Cancer of unknown primary (CUP) is a distinct clinical entity. In Australia in 2013, CUP was the 6thleading cause of cancer death with 2704 new cases seen. CUP refers to a metastatic malignancy for which a standardised diagnostic work-up fails to identify the primary site of origin. CUP is a very heterogeneous disease in which the type of tumour, the extent of disease, and the outcome of treatment all vary widely. CUP patients can be at risk of falling through the gaps of a tumour stream model of care. Although international guidelines for the management of CUP exist, there are currently no national Australian guidelines for CUP care.
The optimal cancer care pathways (OCPs) describe optimal cancer care for specific tumour types. They describe the key stages in a patient’s cancer journey and expected optimal care at each stage to ensure all people affected by cancer get the highest-quality care, regardless of where they live or have their treatment. They are intended to improve patient outcomes by facilitating consistent care based on evidence and best practice. This program of developing OCPs has been undertaken as part of a national work plan developed by the National Cancer Expert Reference Group. The development of OCPs is led by a Project Steering Committee, with the tumour-specific OCPs developed together with a multi-disciplinary Expert Working Group. A project manager based at the Cancer Council Victoria supports all OCP activities.
The CUP OCP is being developed by the Cancer Institute NSW. The Expert Working Group includes clinicians, researchers, consumers and health administrators. The entry point for this OCP is when patients present with a metastatic malignancy without an obvious primary site. The draft CUP OCP has recently been out for public consultation and a final version for national release will be available for presentation.