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A patient is in front of you with a pathological fracture and does not warrant an admission. What tests will you organize and what followup will you arrange? ED can be difficult sometimes because there is no long term followup for patients – it is the responsibility of the ED doctor to arrange followup and prevent unintentional .

This article summarizes:

• Focused assesment for cancer / malignancy risk factors
• Template for some outpatient tests to consider being mindful of how followup can be arranged with aim to reduce risk of loss to followup.

CopyPastable Template and GP Letter Below

for plan/assessment (incl OP investigations), written in the negative, with spiel for followup and safety netting. delete/edit as appropriate:

Dear GP / Oncology Clinician,

Thank you for reviewing [PATIENT], who has presented to ED with a [LESION SUSPICIOUS FOR CANCER]. There is no indication for admission this presentation, but close followup and further tests are indicated.

On Focused Assessment, patient reports
– No family history of cancer.
– Non smoker, non drinker, nil illicit DU
– No overt occupational exposures to hazardous substances.
– No B-Symptoms (Night sweats / unintentional weight loss / bone pain)

Routine Cancer Screenings
– Last PAP smear:
– Last breast screen (mammogram / US):
– Last colonoscopy/gastroscopy:

Hence, the following outpatient workup and followup plan has been initiated.
– CT Brain/Neck/Chest/Abdo/Pelvis ordered as OP
– Serum protein electrophoresis and free light chains.
– Serum CA125, CA153, CEA, CA199
– results from tests above to be sent to GP at _______ and oncology team at _________

Outpatient radiology has been requested, and pt has been instructed to call _____ if ha s not heard from radiology within 2 business days.
Patient has been instructed to seek GP review 2 business days after the radiological investigations for early f/u of results pending outpatient Oncology review. If there are significant findings warranting emergent treatment (eg. Pneumothorax)

A referral to the oncology team, discussed with Dr _____ (Oncology Registrar), has been sent.
A copy of this letter has been provided to the patient to take to their GP.