Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Transforming Cancer of Unknown Primary with Intelligent Diagnostics (CUPID): A retrospective cohort analysis of patients with CUP treated before and after publication of Australia’s Optimal Care Pathway (126496)

Abigail Miller 1 , Tiffany Foo 1 , Michael A Cilento 1 2 3 , Ifrah Hasan 1 , Rebbecca Cato 1 , Anna L Brown 4 , Hamish Scott 4 , Alex Brown 5 6 , Justine Clark 5 , Daniel Thomas 2 3 , Nadia Corsini 7 , Claire M Vajdic 8 , Richard W Tothill 9 10 , Ganessan Kichenadasse 1 11 , Chris S Karapetis 1 11
  1. Medical Oncology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
  2. University of Adelaide, Adelaide, SA, Australia
  3. South Australian Health and Medical Research Institute, Adelaide, SA, Australia
  4. SA Pathology, Adelaide, SA, Australia
  5. The Kids Research Institute Australia, Adelaide, SA
  6. National Centre for Indigenous Genomics, Australian National University, Canberra, ACT
  7. Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
  8. Kirby Institute, University of New South Wales, Kensington, NSW, Australia
  9. Peter MacCallum Cancer Centre, Parkville, VIC, Australia
  10. Sir Peter MacCallum Department of Oncology / Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Parkville, VIC, Australia
  11. College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

Objectives

Cancer of Unknown Primary (CUP) is histologically-confirmed metastatic cancer with no primary site identified during diagnostic workup(1).  Prognosis for patients with CUP is poor(2).  The 2020 CUP Optimal Care Pathway (OCP) defined an approach to managing CUP(3).  Our objective was to assess uptake of OCP recommendations and patient survival outcomes before and after OCP publication.

Sample and setting

Using South Australian Cancer Registry data, we identified adult patients treated for suspected or confirmed CUP at Flinders Medical Centre from 1 January 2010-31 December 2012 and 1 January 2020-31 December 2022.

Procedures

We reviewed case notes, electronic medical records and pharmacy records to extract data regarding demographics, investigations, treatments, and survival. 

Results

52 patients were included for analysis (2010-12 n=33; 2020-22 n=19).  Median age at diagnosis was 71 years (range 40-93); the majority (62%) were male.  Median interval from referral to oncology specialist review was 15.5 days in 2010-12 and 19.0 days in 2020-22 (p=0.80, OCP target within 2 weeks).  93% of patients in 2010-12 and 95% in 2020-22 completed diagnostic workup within 2 weeks of specialist review (p=1.0).  Proportion of patients discussed at a multi-disciplinary meeting was similar across cohorts (59% in 2010-12 vs. 63% in 2020-22, p=1.0).  Proportion who had any PET scan or any molecular test rose over time (27% in 2010-12 vs. 53% in 2020-22 (p=0.08) and 3% vs. 21% (p=0.05), respectively).  There was no difference in 24-month survival between cohorts (27.3% (95% CI 15.6-47.6) in 2010-12 vs. 26.3% (95% CI 12.4-55.8) in 2020-22, p=0.7).

Conclusion

Adherence to key OCP recommendations was similar pre- and post-OCP publication.  Survival outcomes for CUP remain poor.  Prospective research is ongoing.

  1. Varadhachary GR, Raber MN. Cancer of unknown primary site. N Engl J Med 2014;371:757-65.
  2. Cancer Australia. Cancer of unknown primary site in Australia statistics. 2025 Feb 1 [Cited 2025 Jun 4]. Available from URL: https://www.canceraustralia.gov.au/cancer-types/unknown-primary/cancer-unknown-primary-site-australia-statistics#:~:text=and%201%2C180%20females).-,In%202022%2C%20it%20is%20estimated%20that%20a%20person%20has%20a,or%200.61%25%20for%20females).&text=In%202020%2C%20the%20age%2Dstandardised,males%20and%206.5%20for%20females).
  3. Cancer Australia. Optimal care pathway for people with cancer of unknown primary. 2020 [Cited 2025 Jun 4]. Available from URL: https://www.cancer.org.au/assets/pdf/cancer-of-unknown-primary-january-2020