FP3.4 - Identifying missed opportunities in emergency presentations of colorectal cancer to improve patient outcomes

Abstract

Abstract Introduction and Aim A significant proportion of patients diagnosed with colorectal cancer are diagnosed during emergency admissions with presentations such as bowel obstruction, perforation and bleeding. Despite increasing numbers of suspected colorectal cancers referrals from the community being sent straight to test, the proportion of patients presenting as emergencies in the United Kingdom remains at20%. Emergency presentations of colorectal cancer are associated with significantly worse outcomes – both short- and long-term, with research suggestive that emergency presentations remain an independent poor prognostic factor following curative colorectal resection. This study aims to assess if patients diagnosed with colorectal cancer following emergency presentation had missed opportunities of diagnosis on previous presentations in secondary care. Methods A database of patients who have been diagnosed with colorectal cancer following emergency presentation from January2020-October2023 was analysed. Previous attendances to the emergency department and outpatient department were identified and assessed for symptoms of colorectal cancer – including abdominal pain, change in bowel habits, rectal bleeding and iron deficiency anaemia – and if these prompted investigation. Results Of 100 patients – 6were identified that had previous presentations with symptoms suggestive of colorectal malignancy. 2 had been reviewed in colorectal clinic prior to their diagnosis, with appropriate planned investigations but were lost to follow up. A further 4 had been seen in ED with symptoms of colorectal cancer but further investigations were not performed. Conclusion The majority of patients diagnosed with colorectal malignancy following emergency presentation had no earlier opportunities of diagnosis in secondary care. Further work needs to be done ensuring the continuity of care of patients following discharge from both the emergency department and clinic.