Cancer diagnosed by emergency admission in England

Patients diagnosed with cancer by the emergency route often have more advanced diseases and poorer outcomes. Rates of cancer diagnosed through unplanned admissions vary within and between countries, suggesting potential inconsistencies in the quality of care. To reduce diagnoses by this route and improve patient outcomes, high risk patient groups must be identified. In a paper published in BMC Health Services Research, Carmen Tsang and colleagues report the results of a cross-sectional observational study that determined the incidence of first-ever diagnoses of cancer by emergency (unplanned) admission and identified patient-level risk factors for these diagnoses in England.

Data for 74,763 randomly selected patients at 457 general practices between 1999 and 2008 were obtained from the General Practice Research Database (GPRD), including integrated Hospital Episode Statistics (HES) data and Office for National Statistics (ONS) mortality data. The proportion of first-ever diagnoses by emergency admission out of all recorded first cancer diagnoses by any route was analysed by patient characteristics. Diagnosis by emergency admission was recorded in 13.9% of patients diagnosed with cancer for the first time. The incidence of first cases by the emergency route was 2.51 patients per 10,000 person years. In adjusted regression analyses, patients of older age, living in the most deprived areas or who had a total Charlson score of 1 compared to 0 were most at risk of diagnosis by emergency admission. Patients with more prior (all-cause) emergency admissions were less at risk of subsequent diagnosis by the emergency route.

Carmen Tsang and colleagues reported a much lower incidence of first-ever cancer diagnoses by emergency admission compared with previous studies; as well as a decline over time in the proportion of cancer cases diagnosed during an emergency admission. Identified high risk groups may benefit from interventions to reduce delayed diagnosis. Further studies should include screening and cancer staging data to improve understanding of delayed or untimely diagnosis and patient care pathways.