Emergency Care Cancer Diagnosis Linked to Likelihood of Major Surgery

Patients diagnosed in an emergency setting are less likely to undergo major surgery for cancer than those referred to hospital within 2 weeks of being seen by their family physician

medwireNews: A patient’s route to cancer diagnosis significantly predicts their likelihood of major surgery, with the strongest influence found in breast cancer and kidney cancer patients, analysis of English data suggests.

Patients who are diagnosed after an emergency admission are significantly less likely to undergo resection than if their tumour is detected following an urgent two-week wait (TWW) general practitioner (GP) referral to hospital, indicates the study, reported at the Public Health England’s National Cancer Intelligence Network (NCIN) meeting in Belfast, UK.

This was true for 19 out of the 20 tumour sites analysed using National Cancer Data Repository information for 971,329 English patients diagnosed between 2006 and 2010, after adjustment for age and gender, with a nonsignificant difference found only for laryngeal tumours.

The absolute difference in use of surgery was highest for those diagnosed with breast cancer, with approximately 20% of patients undergoing surgery after emergency care versus 80% after a TWW referral.

For kidney cancer patients, the use of surgery was 30% after emergency admission but 70% after TWW referral. The discrepancy by referral was smallest for patients with prostate, pancreas and bladder tumours.

Significant, albeit “much narrower”, differences in the rate of resection were also found for patients diagnosed after urgent TWW referrals versus those diagnosed after a routine GP referral or another type of urgent referral; this was true for 15 tumour sites, not including larynx, hypopharynx, oesophagus, liver and vagina.

The report authors emphasise that the study does not measure the proportion of patients who could or should have undergone major surgery and therefore does not indicate whether or not patients received appropriate or inappropriate treatment.

Nevertheless, Mick Peake, lead clinician at the NCIN, explained in a press release that diagnosis in an emergency admission is already known to be associated with poorer 1-year survival, with patients more likely to have advanced disease unsuitable for major resection.

“These findings offer two key messages; that earlier diagnosis is crucial to improve cancer survival, and that all cancer patients being admitted as an emergency must be assessed by the appropriate specialist team to ensure they receive the optimum treatment”, he said.

Sara Hiom, from Cancer Research UK, also commented on the study. “We next need to look at how the stage at diagnosis via emergency presentations impacts the treatment and as soon as these linked data are available we can complete a more comprehensive analysis.

“Knowing more about when, where and how patients are diagnosed should help us overcome barriers and better plan services to improve cancer survival and patient experience."


National Cancer Intelligence Network: Major resection by routes of diagnosis (2016 to 2010; England). A report produced in partnership with Cancer Research UK. Published online, the page visited last time 9 June 2015.

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