Cancer diagnosed by emergency admission in England: an observational study using the general practice research database

Carmen Tsang,Azeem Majeed,Paul Aylin,Alex Bottle

doi:10.1186/1472-6963-13-308

Abstract

BackgroundPatients 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. This cross-sectional observational study determined the incidence of first-ever diagnoses of cancer by emergency (unplanned) admission and identified patient-level risk factors for these diagnoses in England.MethodsData 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.ResultsDiagnosis by emergency admission was recorded in 13.9% of patients diagnosed with cancer for the first time (n = 817/5870). 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 (p < 0.0001), living in the most deprived areas (RR 1.93, 95% CI 1.51 to 2.47; p < 0.0001) or who had a total Charlson score of 1 compared to 0 (RR 1.34, 95% CI 1.06 to 1.69; p = 0.014) 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 (RR 0.31 per prior emergency admission, 95% CI 0.20 to 0.46; p < 0.0001).ConclusionsA much lower incidence of first-ever cancer diagnoses by emergency admission was found compared with previous studies. 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.

Highlights

Patients diagnosed with cancer by the emergency route often have more advanced diseases and poorer outcomes
Patients diagnosed by emergency admission had up to two cancer diagnoses for that episode of care, with 1.45% of patients recorded as having dual first-ever cancer diagnoses (n = 85/5870)
Further data on cancer screening and waiting times between intervals of care will help to establish which groups are most affected by untimely referral and/or diagnosis, and identify which elements of the care pathway should be targeted for improvement [10]

Summary

Introduction

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 This cross-sectional observational study determined the incidence of first-ever diagnoses of cancer by emergency (unplanned) admission and identified patient-level risk factors for these diagnoses in England. Using national data from hospitals in England (Hospital Episode Statistics, HES), we previously identified patient and general practice characteristics associated with increased risk of cancer diagnosis by emergency admission [11]. The accuracy of case ascertainment (correct identification of patients with a first-ever emergency admission for cancer) was improved by linking hospital data with primary care data for a ten-year study period

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Discussion

Conclusion