'Shocking': Many Cancers in England Diagnosed in the ED

Nick Mulcahy

September 25, 2012

September 25, 2012 — In England, 31% of all cancers in people older than 70 years are diagnosed after presentation to the emergency department (ED) of a hospital, according to a study published online September 20 in the British Journal of Cancer.

For all age groups, 24% of cancers are diagnosed after presentation to the ED.

These findings took the authors by surprise.

"Our findings showing the sheer numbers of cancer patients first seen as an emergency are startling," said coauthor Sara Hiom, who is director of information at Cancer Research UK, a nonprofit group in London, United Kingdom.

"It's truly shocking that, overall, a quarter of people with cancer are diagnosed as a result of an emergency admission," said Sarah Woolnough, executive director of policy at Cancer Research UK, in a press statement issued by that organization. She was not involved in the study.

This study examined the "journey" of 739,667 cancer patients from 2006 to 2008 in England to see how and where they were diagnosed.

It was inspired by the fact that the cancer survival rate in England is lower than in other European countries. This is "partly attributed to later stage at diagnosis," the authors point out.

In every tumor type examined, 1-year relative survival was significantly lower for "emergency presentations" than for any other route of diagnosis, such as referral from a general practitioner (urgent or nonurgent), screen detection, and self-referral.

This lower survival is consistent with other studies showing that outcomes are worse for the "most urgently referred cases," the authors note. There was a higher proportion of older people with an emergency presentation, which might "partly explain" this difference in survival between the emergency patients and those diagnosed through other routes, say the authors.

This study also suggests that healthcare in England discriminates against senior citizens.

"It's deeply concerning that older people are twice as likely as those under 70 to be diagnosed through this route," Woolnough said.

"We might expect older people to have cancer detected as an emergency more frequently than younger people, but the fact that it is happening twice as often in this age group means we urgently need to understand why," she said. "At the moment, the difference in figures suggests ageism in the NHS, which would be unacceptable."

Hiom also speculated about these findings.

"It may be that older people are reluctant to bother their doctor with possible cancer symptoms, or they could be slipping through the net because symptoms may be dismissed as 'the usual aches and pains' or 'old age', or their general practitioner could have referred them [to a specialist] but their condition progressed so rapidly that they ended up as an emergency in hospital," she said in a press statement.

Many Brain and Central Nervous System Cancers

Most of the cancers in this study were diagnosed after presentation to the ED (24%), urgent referral from a general practitioner to a specialist (26%), or a nonurgent referral from a general practitioner (21%). The other 5 routes, including cancer screening, accounted for the remaining 29% of cases.

For patients whose cancer is diagnosed after presentation to the ED, there are a variety of reasons for their ED visit, such as cancer symptoms, an emergency such as a broken hip, and being sent straight to the ED by their doctor because of severe symptoms.

Some cancers were more likely than others to be diagnosed by this route. For instance, during the study period, 62% of all cancers of the brain and central nervous system were diagnosed after presentation to the ED, as were 50% of pancreatic cancers and 39% of lung cancers.

Understandably, more easily detected cancers were rarely diagnosed after presentation to the ED, such as those of the skin (3%) and breast (5%).

The study was funded by the National Cancer Intelligence Network. The authors have disclosed no relevant financial relationships.

Br J Cancer. Published online September 20, 2012. Abstract

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