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Poorer prognosis if cancer diagnosed as emergency

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Diagnosis of cancer as a medical emergency leads to poorer prognosis for many patients, regardless of tumour stage, and is not just a problem for the NHS, according to UK researchers.

Too many patients, particularly those from disadvantaged backgrounds, are being diagnosed with cancer as medical emergencies, they warned in the journal Nature Reviews Clinical Oncology.

“We need to find out why they are not seeking medical help sooner”

Georgios Lyratzopoulos

The study, jointly led by the University of Cambridge and University College London, reviewed current evidence from 26 peer-reviewed studies and six online reports from seven countries.

The evidence indicated that emergency cancer diagnosis was a universal problem, challenging previous assumptions that it was a particular problem only in the UK, noted the authors.

Looking at prognosis alone, they found evidence showing patients diagnosed with colorectal cancer at emergency presentation had a 50% one-year survival rate, compared to 82% for electives.

Similarly, for lung cancer, the respective survival rates were 12% versus 40% – in part because cancer diagnosed at emergency care was more likely to be at an advanced stage.

However, even when patients presented with tumours of the same disease stage, they still had a worse prognosis if they were diagnosed in emergency care, highlighted the researchers.

This was possibly because of problems in the quality of their management out-of-hours, or because they have more aggressive disease on a stage-for-stage basis, they suggested.

In the UK, the study authors noted that about three in 10 emergency presenters are referred to hospital emergency services by their GP, but others self-presented to accident and emergency.

Patients at both ends of the age spectrum were most likely to have their cancer diagnosed in emergency contexts, the study found, though differences between genders were unclear.

However, the review found particular inequalities between socio-economic groups. It found patients from more deprived backgrounds were at a greater risk of being diagnosed at emergency care. The same was true for people of Asian ethnicity in the UK and African-Americans in the US.

University College London

Poorer prognosis if cancer diagnosed as emergency

Georgios Lyratzopoulos

Study author Dr Georgios Lyratzopoulos, from University College London, said: “A substantial minority of cancer patients who are diagnosed as emergencies do not seem to have had prior contact with the formal healthcare system.

“We need to find out why they are not seeking medical help sooner,” he said. “Is it because they are unaware of any symptoms until too late, or is it because they do not think the symptoms are a sign of a more serious problem?”

Evidence pointed towards developing new screening methods and improving participation in existing screening programme as one possible way to reduce emergency presentations in the medium to longer term, said the researchers.

For example, based on indirect evidence in one geographical region in the UK, the introduction of faecal occult blood test in the UK was likely to have reduced the proportion of patients with colorectal cancer diagnosed as emergencies by half between 1999 and 2004.

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