Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

From diagnostic uncertainty to coordinated care: Mid-trial implementation lessons from a consumer-informed new model of care for suspected cancer of unknown origin (SUPER-ED Trial) (146051)

Natalie Richards 1 , Tharani Sivakumaran 1 2 , Sarah McLean 3 , Dunithi Samarasekera 1 , Amy Agar 1 4 , Cindy Bryant 5 , Anna Ugalde 6 , Catherine Mitchell 2 7 , Tim Akhurst 8 , Hyun Ko 2 8 , Anna Kuchel 9 10 , Bo Gao 11 12 13 , Chloe Georgiou 14 , Christopher Steer 15 , Gordon Ratcliff 16 , Ian Collins 17 18 , Kortnye Smith 19 , Louise Nott 20 , Madhu Singh 21 , Mark Shackleton 22 23 , Mark Wong 13 , Narayan Karanth 24 , Shamsudheen Padinharakam 25 , Zee Wan Wong 26 27 , SUPER-ED Consumer Committee 5 , Nilmini Wickramasinghe 4 28 , Mathias Bressel 2 29 , Louisa Collins 30 31 32 , Hui Li Wong 1 2 , Richard Tothill 2 33 34 , Linda Mileshkin 1 2
  1. Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
  3. Specialist Nursing, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  4. Swinburne University of Technology, Melbourne, VIC, Australia
  5. Consumer Steering Committee, Solving Unknown Primary Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  6. Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
  7. Department of Pathology, Peter MacCalum Cancer Centre, Melbourne, VIC, Australia
  8. Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  9. University of Queensland, Brisbane, QLD, Australia
  10. Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
  11. Medical Oncology, Blacktown Hospital, Sydney, NSW, Australia
  12. Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  13. Medical Oncology, Westmead Hospital, Sydney, NSW, Australia
  14. Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
  15. Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
  16. Medical Oncology, Peninsula University Hospital, Frankston, VIC, Australia
  17. Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Geelong, VIC, Australia
  18. Medical Oncology, Southwest Healthcare, Warrnambool, VIC, Australia
  19. Medical Oncology, Eastern Health, Melbourne, VIC, Australia
  20. Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
  21. Medical Oncology, Barwon Health, Geelong, VIC, Australia
  22. Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
  23. School of Translational Medicine, Monash University, Melbourne, VIC, Australia
  24. Medical Oncology, Royal Darwin Hospital, Darwin, NT, Australia
  25. Medical Oncology, Launceston General Hospital, Launceston, TAS, Australia
  26. Medical Oncology, Monash Health, Clayton, VIC, Australia
  27. School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
  28. Latrobe University, Bundoora, VIC, Australia
  29. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  30. Cancer Council Queensland, Brisbane, VIC, Australia
  31. Faculty of Health, Medicine and Behavioural Sciences , University Queensland, Brisbane, VIC, Australia
  32. School of Nursing, Queensland University of Technology, Brisbane, Victoria, Australia
  33. Collaborative Centre for Genomic Cancer Medicine, The University of Melbourne, Melbourne, VIC, Australia
  34. Department of Clinical Pathology, The University of Melbourne, Melbourne, VIC, Australia

Background

Patients undergoing diagnostic evaluation for suspected cancer of unknown origin frequently experience fragmented care, diagnostic uncertainty and delayed access to specialist expertise. The SUPER-ED (Solving Unknown Primary cancER Earlier Diagnosis) trial was developed to address these challenges through a coordinated model of care incorporating standardised diagnostic pathways, embedded Care Coordinators, a national virtual multidisciplinary meeting (MDM) and an educational website resource1.

Study Design

SUPER-ED is a national, multi-site stepped-wedge cluster randomised controlled trial across 15 Australian health services (target n=240). Following a period of standard care, sites cross over to the intervention phase with implementation of the model of care described above. Recruitment is ongoing (Feb 25 to May 27). Mid-trial implementation was reviewed and refined to identify barriers, guide service improvements and support adaptation of the model.

Progress

115 participants have been recruited, with 10 of 15 sites in the intervention phase; the remaining five sites cross over in Oct 26. MDM: To date, 12 national virtual MDMs have reviewed 24 complex cases; a primary or suspected tissue of origin was identified in 9 cases, informing investigations, treatment decisions and specialist referrals. Implementation challenges include referral uptake, imaging transfer and access to molecular testing. Care Coordinators: Implemented at all sites (10/10), with varied local workforce models across nursing and research. Sites reported improved care coordination and continuity, although challenges included role integration and clinician engagement.  Patient-centred language: Consumer and clinician feedback led to the adoption of “suspected cancer” terminology across patient materials and website resources, aligning with real-world diagnostic pathways and informed by the UK CUP World Alliance.

Conclusion

Mid-trial lessons from SUPER-ED demonstrate the value of multidisciplinary networks and consumer partnership in identifying implementation barriers, informing service redesign, and supporting the delivery of a new model of care across multiple health services.

  1. 1 Ugalde A, Tothill RW, Quinn S, et al. Solving unknown primary cancer with earlier diagnosis: the SUPER-ED trial: study protocol for a stepped-wedge cluster randomised