{"entity":{"id":"idea-tr1-pathology-triggered-referral","kind":"idea","name":"The pathology lab triggers a trial referral the day a rare cancer is diagnosed","aka":[],"tldr":"The pathologist is the first person to know a cancer is rare or has a targetable marker. A rule in the lab system could notify a trial team at that moment, before treatment decisions close the window.","summary":"Laboratory information systems flag defined diagnoses (rare histologies, MSI-high, NTRK fusion, specific paediatric-type tumours in adults) and send a structured notification to a regional trial coordination office and the treating clinician, with matched trials attached. Consent-to-contact rules govern direct patient contact. Precedents exist in stroke and sepsis alerting; oncology pathology alerting has been used for HER2 and MSI testing completeness.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Trials enrol too few, too slowly): Unger et al., Systematic review of barriers to cancer trial participation (JNCI 2019)","url":"https://doi.org/10.1093/jnci/djy221"}],"tags":[],"related":[],"cancers":["sarcoma","neuroendocrine"],"sections":[],"technologies":["histopathology-ihc","digital-pathology-ai"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["msi","gene-fusion","first-line"],"trials":[],"people":[],"bottlenecks":["b-trial-enrolment","b-rare-cancers"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Pathology-triggered referral will increase the proportion of patients with the flagged diagnoses seen by a trial team before first-line treatment, and enrolment in first-line trials for those diagnoses.","rationale":"For many rare cancers the only trial is first-line; once standard chemotherapy starts, the patient is ineligible. Diagnosis-time alerting acts before the window closes.","test":"Implement in one regional pathology network for five diagnoses; compare pre-treatment trial-team contact rate and first-line trial enrolment with neighbouring regions.","maturity":"speculative","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-tr1-pathology-triggered-referral/","neighbours":{"cancer":[{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"},{"id":"sarcoma","kind":"cancer","name":"Sarcomas (soft tissue, bone, GIST)","route":"/cancers/sarcoma/"}],"technology":[{"id":"digital-pathology-ai","kind":"technology","name":"Digital pathology & AI","route":"/technologies/digital-pathology-ai/"},{"id":"histopathology-ihc","kind":"technology","name":"Histopathology & immunohistochemistry","route":"/technologies/histopathology-ihc/"}],"term":[{"id":"gene-fusion","kind":"term","name":"Gene fusion","route":"/terms/gene-fusion/"},{"id":"first-line","kind":"term","name":"Lines of therapy","route":"/terms/first-line/"},{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"}],"bottleneck":[{"id":"b-rare-cancers","kind":"bottleneck","name":"Rare and paediatric cancers without markets","route":"/bottlenecks/b-rare-cancers/"},{"id":"b-trial-enrolment","kind":"bottleneck","name":"Trials enrol too few, too slowly","route":"/bottlenecks/b-trial-enrolment/"}]}}