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Unplanned first-time admissions for cancer

Cancer survival in the United Kingdom is poorer than in many other European countries. For many patients with cancer, their diagnosis is first made when they are admitted to hospital as an emergency with complications of cancer. Hence, studying patients in whom cancer is diagnosed in this sway may provide information that can be used to improve the detection of cancer by the NHS. In a paper published recently in the British Journal of Cancer, Alex Bottle and colleagues from the Department of Primary Care & Public Health at Imperial College London examined patient and general practice characteristics associated with emergency (unplanned) first hospital admissions for cancer in England.

They reported that there were around 640,000 patients with a first-time admission for cancer, of which around 140,000 were unplanned, coming from 7957 GP practices. The unplanned proportion ranged from 14% (patients aged 15–44 years) to 45% (patients aged 85 years and older), with a large variation by patient characteristics such as ethnicity, deprivation, rurality and type of cancer. In unadjusted analyses, all patient and practice-level variables examined in the paper were statistically significant predictors of unplanned admissions. After adjustment, deprivation remained an important predictive factor for unplanned admission. Practices with higher total QOF (pay for performance) scores had lower rates of unplanned first-time admissions for cancer, as did practices that were able to offer more appointments within 48 hours. When cancer site was examined, cancer of the brain or CNS, pancreatic cancer and acute leukaemia had the highest risk of diagnosis during an unplanned admission relative to an elective admission.

Alex Bottle and colleagues have identified some patient and practice characteristics associated with a higher risk of first-time admission for cancer being unplanned. These findings could be used to help identify patients at high risk of late diagnosis of cancer. They also raise questions about the role of general practice organisation and access to primary care in improving the early detection of cancer. The article was featured by a number of organisations and newspaper, including Cancer Research UK and the Daily Mail.

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