Diagnosis of cancer as a medical emergency leads to poorer prognosis for many patients

October 11, 2016
Diagnosis of cancer as a medical emergency leads to poorer prognosis for many patients
Credit: Craig Brierley

Too many patients – particularly those from disadvantaged backgrounds – are being diagnosed with cancer as medical emergencies, say researchers. This means that their chances of successful treatment are greatly reduced.

In an article in the journal Nature Reviews Clinical Oncology, a team of jointly led by the University of Cambridge and University College London reviewed current evidence from 26 peer-reviewed studies and 6 online reports from 7 countries. The evidence indicates that emergency diagnosis of cancer is a universal problem, challenging previous assumptions regarding this issue being a particular problem only in the UK.

Looking at prognosis alone, the researchers reviewed evidence that showed that patients diagnosed with at emergency presentation had a 50% one year survival rate, compared to 82% for patients diagnosed electively - in other words, following a GP referral to a specialist. Similarly, for lung cancer the respective survival rates were 12% versus 40%. This was in part because cancer diagnosed at emergency care was more likely to be at an advanced stage. However, this was not the full story: even when patients presented with tumours of the same disease stage they still had a worse prognosis if they were diagnosed in emergency care, 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.

In the UK, about three in 10 emergency presenters are referred to hospital emergency services by their family doctors, but others self-present to accident and emergency departments. Patients at both ends of the age spectrum – the youngest and the oldest – were most likely to have their cancer diagnosed in emergency contexts. Differences between genders were unclear – and vary for different types of cancer.

However, the review found particular inequalities between socioeconomic groups. Although the evidence came only from studies looking at colorectal and lung cancer, it found that people 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 USA.

First author Dr Yin Zhou from the Primary Care Unit at the University of Cambridge, who led the study, says: "The earlier an individual can get a diagnosis of cancer, the better the prognosis and the options for treatment. When the first time their cancer is identified is when it becomes an emergency, the prognosis is much worse."

Dr Georgios Lyratzopoulos, who instigated and coordinated the collaboration, based at the Department of Epidemiology and Public Health, University College London adds: "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. 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?"

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

"What was clear from our review," adds Dr Zhou, "is how little data there is available about emergency diagnoses. What little data there is suggests that we're only seeing the tip of the iceberg and that this could be a much bigger problem, particularly in low and middle income countries."

Major part of the global evidence on emergency presentations (in terms of patient numbers) relates to English patients – thanks to the pioneering Routes to Diagnosis project and population-based data collected by the National Cancer Registration and Analysis Services of Public Health England.

Explore further: Older people at higher risk of emergency cancer diagnosis

More information: Yin Zhou et al. Diagnosis of cancer as an emergency: a critical review of current evidence, Nature Reviews Clinical Oncology (2016). DOI: 10.1038/nrclinonc.2016.155

Related Stories

Older people at higher risk of emergency cancer diagnosis

April 1, 2015
People over 60 are at higher risk of being diagnosed with lung or bowel cancer as an emergency in hospital than younger people, according to a Cancer Research UK-supported report , published today by BMJ Open.

Women four times less likely to have surgery if breast cancer diagnosed as an emergency

June 8, 2015
Breast cancer patients are four times less likely to have potentially lifesaving surgery if diagnosed as an emergency rather than through an urgent GP referral, according to a new data published today (Monday).

Screening gets top marks for picking up bowel cancer early

January 21, 2016
BOWEL cancer is more likely to be diagnosed at the earliest stage if it is picked up by screening, according to new figures released by Cancer Research UK and Public Health England's National Cancer Intelligence Network today ...

Patients with emergency-diagnosed lung cancer report barriers to seeing their GP

November 4, 2014
Many patients whose lung cancer is diagnosed as an emergency in hospital reported difficulties in previously seeing their GP, according to research presented at the National Cancer Research Institute (NCRI) Cancer Conference ...

Race, socioeconomics had impact on emergency colorectal cancer diagnosis

October 17, 2012
Twenty-nine percent of patients with colorectal cancer in a nationally representative sample were diagnosed after an emergency, such as an obstruction or perforation of the bowel, according to data presented at the 11th Annual ...

Delirium in advanced cancer patients often goes undetected in the emergency department

July 25, 2016
A new study indicates that delirium is relatively frequent and underdiagnosed by physicians in patients with advanced cancer visiting the emergency department. Delirium was similarly common among older and younger patients, ...

Recommended for you

No dye: Cancer patients' gray hair darkened on immune drugs

July 21, 2017
Cancer patients' gray hair unexpectedly turned youthfully dark while taking novel drugs, and it has doctors scratching their heads.

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.