We analysed data from the National Cancer Diagnosis Audit (NCDA) for patients diagnosed with cancer in England during 2018. We wanted to understand the factors linked to emergency cancer diagnoses and their association with patient outcomes. This work was carried out in partnership with the National Disease Registration Service and the National Cancer Diagnosis Audit Methodology Group. Being diagnosed with cancer following emergency care is associated with poorer outcomes for patients.
One in five patients (19%) were diagnosed through an emergency care pathway:
4% through emergency referral only (emergency GP referral or self-referral to an emergency department)
7% through emergency hospital admission only
8% through a combination of both
Patients with higher co-morbidity, deprivation, advanced disease stage and certain cancer types were more likely to be diagnosed through an emergency route.
Those patients who had both an emergency referral and an emergency hospital admission were diagnosed faster – 5 days compared to 24 days for emergency referral only and 23 days for emergency hospital admission only. This is likely due to more severe symptoms being diagnosed more promptly. However, these patients had poorer short-term mortality outcomes compared other groups.
A third of patients who had an emergency diagnosis via hospital admission had also been referred on an Urgent Suspected Cancer pathway.
All patients saw a GP at least once before an emergency referral, but a third of these self-referred to A&E. This is likely due to worsening of symptoms while waiting for investigations, referral or a hospital appointment. In some cases, it may reflect primary care clinicians not recognising the need for further assessment.
For some patients, an emergency diagnosis may have been appropriate at the time. However, there were cases where earlier investigation or referral could have avoided an emergency admission.
Understanding emergency pathways can help identify opportunities for earlier diagnosis. For example, patients who start on a non-emergency pathway but later require emergency diagnosis could benefit from interventions that speed up their diagnostic process.
Ruth Swann, Georgios Lyratzopoulos, Greg Rubin, Lucy Elliss-Brookes, Sean McPhail.
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