The Suspected CANcer (SCAN) pathway::protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

Introduction Cancer survival in England lags behind most European countries, due partly to lower rates of early stage diagnosis. We report the protocol for the evaluation of a multidisciplinary diagnostic centre-based pathway for the investigation of ‘low-risk but not no-risk’ cancer symptoms called the Suspected CANcer (SCAN) pathway. SCAN is a new standard of care being implemented in Oxfordshire; one of a number of pathways implemented during the second wave of the Accelerate, Coordinate, Evaluate (ACE) programme, an initiative which aims to improve England’s cancer survival rates through establishing effective routes to early diagnosis. Methods and analysis To evaluate SCAN, we are collating a prospective database of patients referred onto the pathway by their general practitioner (GP). Patients aged over 40 years, with non-specific symptoms such as weight loss or fatigue, who do not meet urgent cancer referral criteria or for whom symptom causation remains unclear after investigation via other existing pathways, can be referred to SCAN. SCAN provides rapid CT scanning, laboratory testing and clinic review within 2 weeks. We will follow all patients in the primary and secondary care record for at least 2 years. The data will be used to understand the diagnostic yield of the SCAN pathway in the short term (28 days) and the long term (2 years). Routinely collected primary and secondary care data from patients not referred to SCAN but with similar symptoms will also be used to evaluate SCAN. We will map the routes to diagnosis for patients referred to SCAN to assess cost-effectiveness. Acceptability will be evaluated using patient and GP surveys. Ethics and dissemination The Oxford Joint Research Office Study Classification Group has judged this to be a service evaluation and so outside of research governance. The results of this project will be disseminated by peer-reviewed publication and presentation at conferences

'Friends are the family we choose for ourselves': Young people and families in the TV series Buffy the Vampire Slayer

The young people at the centre of Buffy the Vampire Slayer present themselves as an alternative family that contrasts with the programme’s conventional families. This device helps to raise awareness about changing family structures in contemporary Western society, particularly with respect to the family’s capacity to facilitate the development of young people. The series implies that the stability associated with the nuclear family is often illusory and/or achieved at the price of young people’s freedom and agency. The alternative structure, by contrast, answers the call for the ‘democratisation’ of the family (Giddens, 1999) and is coded positively in spite of many weaknesses