# A dedicated clinic for people whose blood test says the cancer is back

Source: https://onco.cc/ideas/idea-bio2-mrd-clinic-service/  
OnCo record `idea-bio2-mrd-clinic-service` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A positive leftover-cancer blood test leaves patients frightened and their doctors unsure what to do. A specialist clinic could give them a plan and a trial.

## Summary

The molecular relapse population is growing fast and falls between services: no visible disease, no standard therapy, high anxiety and low trial awareness. A named clinic (confirmatory retesting, sensitive imaging, psychological support, trial screening and structured follow-up) is a service-design intervention that could be evaluated like any other pathway.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A dedicated molecular relapse clinic increases trial enrolment among ctDNA-positive patients threefold and reduces anxiety scores compared with usual follow-up, with no increase in cost per patient once inappropriate imaging is avoided.
- Rationale: Analogous focused services (rapid diagnostic centres, cancer of unknown primary clinics, cardio-oncology) improved both pathway metrics and enrolment. The bottleneck for MRD trials is not eligibility but the absence of anyone whose job it is to act on the result.
- Proposed test: Two-centre service pilot with pre-specified metrics: time from positive result to plan, trial enrolment rate, imaging use, patient-reported anxiety at three months.
- Maturity: speculative
- Actor: clinic

## Sources

- Bottleneck evidence (Dormant cells and minimal residual disease): Tie et al., ctDNA analysis guiding adjuvant therapy in stage II colon cancer (NEJM 2022): https://doi.org/10.1056/NEJMoa2200075

## Connected records

- technologies: [AI trial matching & clinical decision support](https://onco.cc/technologies/ai-trial-matching/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- terms: [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/)

---
JSON: https://onco.cc/api/v1/entities/idea-bio2-mrd-clinic-service.json