Emergency Presentation Research Articles

Application of a digital quality measure for cancer diagnosis in Epic Cosmos.

Missed and delayed cancer diagnoses are common, harmful, and often preventable. We previously validated a digital quality measure (dQM) of emergency presentation (EP) of lung cancer in 2 US health systems. This study aimed to apply the dQM to a new national electronic health record (EHR) database and examine demographic associations. We applied the dQM (emergency encounter followed by new lung cancer diagnosis within 30 days) to Epic Cosmos, a deidentified database covering 184 million US patients. We examined dQM associations with sociodemographic factors. The overall EP rate was 19.6%. EP rate was higher in Black vs White patients (24% vs 19%, P < .001) and patients with younger age, higher social vulnerability, lower-income ZIP code, and self-reported transport difficulties. We successfully applied a dQM based on cancer EP to the largest US EHR database. This dQM could be a marker for sociodemographic vulnerabilities in cancer diagnosis.

Outcomes for Emergency Presentations of Lung Cancer: A Scoping Review

BackgroundLung cancer is frequently detected during visits to the emergency department (ED). The ED is crucial for identifying likely cases of lung cancer and coordinating the subsequent care for these patients. ObjectivesThis scoping review aims to explore the definitions of emergency presentations (EPs) of lung cancer, along with mortality rates, cancer stage, and treatments for patients diagnosed with lung cancer following an EP. MethodsWe conducted a scoping review of the literature on EPs of lung cancer, identifying 27 relevant articles out of 1,338 initially screened. ResultsMost studies originated from the United Kingdom, collectively reporting over 270,000 EPs of lung cancer. The majority of included studies provided strong evidence. Key findings revealed higher mortality rates among patients diagnosed with lung cancer through emergency presentations, with a significant proportion presenting at advanced stages. Patients with EPs were less likely to undergo surgical removal or receive radiotherapy. Lastly, only 66.7% of the studies defined an EP, with great heterogeneity among EP definitions. Methodological differences precluded meta-analysis. ConclusionDespite methodological heterogeneity, our synthesis indicates that patients presenting acutely with undiagnosed lung cancer often present at advanced stages and experience high mortality rates. These findings underscore the need for further research to develop evidence-based interventions for improving outcomes among ED patients with suspected lung cancer.

Minorities Face Delays to Pancreatic Cancer Treatment Regardless of Diagnosis Setting

IntroductionOur analysis was designed to characterize the demographics and disparities between the diagnosis of pancreas cancer during emergency presentation (EP) and the outpatient setting (OP) and to see the impact of our institutions pancreatic multidisciplinary clinic (PMDC) on these disparities.MethodsInstitutional review board-approved retrospective review of our institutional cancer registry and PMDC databases identified patients diagnosed/treated for pancreatic ductal adenocarcinoma between 2014 and 2022. Chi-square tests were used for categorical variables, and one-way ANOVA with a Bonferroni correction was used for continuous variables. Statistical significance was set at p < 0.05.ResultsA total of 286 patients met inclusion criteria. Eighty-nine patients (31.1%) were underrepresented minorities (URM). Fifty-seven (64.0%) URMs presented during an EP versus 100 (50.8%) non-URMs (p = 0.037). Forty-one (46.1%) URMs were reviewed at PMDC versus 71 (36.0%) non-URMs (p = 0.10). No differences in clinical and pathologic stage between the cohorts (p = 0.28) were present. URMs took 22 days longer on average to receive treatment (66.5 days vs. 44.8 days, p = 0.003) in the EP cohort and 18 days longer in OP cohort (58.0 days vs. 40.5 days, p < 0.001) compared with non-URMs. Pancreatic Multidisciplinary Clinic enrollment in EP cohort eliminated the difference in time to treatment between cohorts (48.3 days vs. 37.0 days; p = 0.151).ResultsUnderrepresented minorities were more likely to be diagnosed via EP and showed delayed times to treatment compared with non-URM counterparts. Our PMDC alleviated some of these observed disparities. Future studies are required to elucidate the specific factors that resulted in these findings and to identify solutions.

Development and Implementation of a Digital Quality Measure of Emergency Cancer Diagnosis.

Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure's association with missed opportunities for diagnosis (MODs) and mortality. On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. We identified EPs for lung cancer and colorectal cancer (CRC) in the Department of Veterans Affairs (VA) and Geisinger from 2016 to 2020. We validated measure accuracy and identified preceding MODs through standardized chart review of 100 records per cancer per health system. Using VA's longitudinal encounter and mortality data, we applied logistic regression to assess EP's association with 1-year mortality, adjusting for cancer stage and demographics. Among 38,565 and 2,914 patients with lung cancer and 14,674 and 1,649 patients with CRCs at VA and Geisinger, respectively, our dQM identified EPs in 20.9% and 9.4% of lung cancers, and 22.4% and 7.5% of CRCs. Chart reviews revealed high positive predictive values for EPs across sites and cancer types (72%-90%), and a substantial percent represented MODs (48.8%-84.9%). EP was associated with significantly higher odds of 1-year mortality for lung cancer and CRC (adjusted odds ratio, 1.78 and 1.83, respectively, 95% CI, 1.63 to 1.86 and 1.61 to 2.07). A dQM for cancer EP was strongly associated with both mortality and MODs. The findings suggest a promising automated approach to measuring quality of cancer diagnosis in US health systems.

What can hospital emergency admissions prior to cancer diagnosis tell us about socio-economic inequalities in cancer diagnosis? Evidence from population-based data in England

BackgroundMore deprived cancer patients are at higher risk of Emergency Presentation (EP) with most studies pointing to lower symptom awareness and increased comorbidities to explain those patterns. With the example of colon cancer, we examine patterns of hospital emergency admissions (HEAs) history in the most and least deprived patients as a potential precursor of EP.MethodsWe analysed the rates of hospital admissions and their admission codes (retrieved from Hospital Episode Statistics) in the two years preceding cancer diagnosis by sex, deprivation and route to diagnosis (EP, non-EP). To select the conditions (grouped admission codes) that best predict emergency admission, we adapted the purposeful variable selection to mixed-effects logistic regression.ResultsColon cancer patients diagnosed through EP had the highest number of HEAs than all the other routes to diagnosis, especially in the last 7 months before diagnosis. Most deprived patients had an overall higher rate and higher probability of HEA but fewer conditions associated with it.ConclusionsOur findings point to higher use of emergency services for non-specific symptoms and conditions in the most deprived patients, preceding colon cancer diagnosis. Health system barriers may be a shared factor of socio-economic inequalities in EP and HEAs.

Routes to diagnosis for hepatocellular carcinoma patients: predictors and associations with treatment and mortality

BackgroundHepatocellular carcinoma (HCC) incidence has increased rapidly, and prognosis remains poor. We aimed to explore predictors of routes to diagnosis (RtD), and outcomes, in HCC cases.MethodsHCC cases diagnosed 2006–2017 were identified from the National Cancer Registration Dataset and linked to Hospital Episode Statistics and the RtD metric. Multivariable logistic regression was used to explore associations between RtD, diagnosis year, 365-day mortality and receipt of potentially curative treatment.Results23,555 HCC cases were identified; 36.1% via emergency presentation (EP), 30.2% GP referral (GP), 17.1% outpatient referral, 11.0% two-week wait and 4.6% other/unknown routes. Odds of 365-day mortality was >70% lower via GP or OP routes than EP, and odds of curative treatment 3–4 times higher. Further adjustment for cancer/cirrhosis stage attenuated the associations with curative treatment. People who were older, female, had alcohol-related liver disease, or were more deprived, were at increased risk of an EP. Over time, diagnoses via EP decreased, and via GP increased.ConclusionsHCC RtD is an important predictor of outcomes. Continuing to reduce EP and increase GP and OP presentations, for example by identifying and regularly monitoring patients at higher risk of HCC, may improve stage at diagnosis and survival.

Retrospective review of patients with lung cancer presenting emergently

BackgroundA significant proportion of lung cancer patients receive their diagnosis as part of an emergency presentation (EPs) to emergency departments (EDs). ObjectivesThis study aimed to describe EPs of lung cancer at a safety-net hospital system. MethodsWe conducted a retrospective analysis of patients with lung cancer at a safety-net ED. EP was defined as a diagnosis of lung cancer due to an acute presentation with symptoms of undiagnosed lung cancer (e.g., cough, hemoptysis, shortness of breath). Non-EPs were the result of either incidental findings (trauma pan-scan) or as part of lung cancer screening. ResultsA total of 333 patient charts were reviewed who had lung cancer. Of those, 248 (74.5%) were defined as having an EP. EPs were more likely stage IV than non-EPs (50.4% vs 32.9%). The percent mortality was higher for EP versus non-EP, 60.0% vs 49.4%. which is driven by a high mortality rate for stage IV EPs (77.5%). Most patients with an EP were seen in the ED (177, 71.4%) as the location of initial visit that had a workup concerning for lung cancer. Most of the EPs were admitted for completion of either their diagnostic work up and/or for symptom management (117, 66.5%). Logistic regression identified significant predictors for an EP including stage IV at diagnosis (OR 2.49, 95% CI 1.39–4.48) and lack of primary care (OR 0.07, 95% CI 0.009–0.53). ConclusionMost patients with lung cancer present acutely as an EP with advanced stage in a safety-net health care setting. The ED plays an important role in the initial diagnosis of lung cancer and coordinating subsequent cancer care.

An Economic Model to Establish the Costs Associated With Routes to Presentation for Patients With Multiple Myeloma in the United Kingdom

ObjectivesPatients with myeloma often face significant diagnostic delay, with up to one-third of UK patients diagnosed after an emergency presentation (EP). Compared with other routes, patients presenting as an emergency have more advanced disease, increased complications, and poorer prognosis. MethodsAn economic model was developed using a decision-tree framework and lifetime time horizon to estimate costs related to different presentation routes (EP, general practitioner [GP] 2-week wait, GP urgent, GP routine, and consultant to consultant) for UK patients diagnosed as having myeloma. After diagnosis, patients received one of 3 first-line management options (observation, active treatment, or end-of-life care). Inputs were derived from UK health technology assessments and targeted literature reviews, or based on authors’ clinical experience where data were unavailable. Active treatment, complication, and end-of-life care costs were included. ResultsThe average per-patient cost of treating myeloma (across all routes) was estimated at £146 261. The average per-patient cost associated with EP (£152 677) was the highest; differences were minimal compared with GP 2-week wait (£149 631) and consultant to consultant (£147 237). GP urgent (£140 025) and GP routine (£130 212) were associated with marginally lower costs. Complication (£42 252) and end-of-life care (£11 273) costs were numerically higher for EP than other routes (£25 021-£38 170 and £9772-£10 458, respectively). ConclusionsAn economic benefit may be associated with earlier diagnosis, gained via reduced complication and end-of-life care costs. Strategies to expedite myeloma diagnosis and minimize EPs have the potential to improve patient outcomes and may result in long-term savings that could offset any upfront costs associated with their implementation.

Do presenting symptoms, use of pre-diagnostic endoscopy and risk of emergency cancer diagnosis vary by comorbidity burden and type in patients with colorectal cancer?

BackgroundCancer patients often have pre-existing comorbidities, which can influence timeliness of cancer diagnosis. We examined symptoms, investigations and emergency presentation (EP) risk among colorectal cancer (CRC) patients by comorbidity status.MethodsUsing linked cancer registration, primary care and hospital records of 4836 CRC patients (2011–2015), and multivariate quantile and logistic regression, we examined variations in specialist investigations, diagnostic intervals and EP risk.ResultsAmong colon cancer patients, 46% had at least one pre-existing hospital-recorded comorbidity, most frequently cardiovascular disease (CVD, 18%). Comorbid versus non-comorbid cancer patients more frequently had records of anaemia (43% vs 38%), less frequently rectal bleeding/change in bowel habit (20% vs 27%), and longer intervals from symptom-to-first relevant test (median 136 vs 74 days). Comorbid patients were less likely investigated with colonoscopy/sigmoidoscopy, independently of symptoms (adjusted OR = 0.7[0.6, 0.9] for Charlson comorbidity score 1–2 and OR = 0.5 [0.4–0.7] for score 3+ versus 0. EP risk increased with comorbidity score 0, 1, 2, 3+: 23%, 35%, 33%, 47%; adjusted OR = 1.8 [1.4, 2.2]; 1.7 [1.3, 2.3]; 3.0 [2.3, 4.0]) and for patients with CVD (adjusted OR = 2.0 [1.5, 2.5]).ConclusionsComorbid individuals with as-yet-undiagnosed CRC often present with general rather than localising symptoms and are less likely promptly investigated with colonoscopy/sigmoidoscopy. Comorbidity is a risk factor for diagnostic delay and has potential, additionally to symptoms, as risk-stratifier for prioritising patients needing prompt assessment to reduce EP.

P-010: An economic model to establish the costs associated with routes of presentation for patients with Myeloma in the UK

<h3>Background</h3> Patients with myeloma often face significant diagnostic delay, with over a quarter of patients in the UK diagnosed following emergency presentation (EP) [1]. Compared with other presentation routes, patients presenting as an emergency have more advanced disease, increased complications and poorer prognosis. <h3>Methods</h3> An economic model was developed using a decision-tree framework and a lifetime time horizon to estimate costs related to presentation routes (EP, general practitioner [GP] suspected cancer referral with a maximum two-week wait [TWW], GP urgent, GP routine and consultant-to-consultant, categorised by Howell et al [2017] [1]) for patients diagnosed with myeloma in the UK. Following diagnosis, patients received one of three first-line management options (observation, active treatment with anti-myeloma drugs, or end-of-life [EOL] care). Those receiving observation were assumed to have a diagnosis of smouldering myeloma but could progress to active myeloma and receive active treatment. Inputs were derived from UK health technology assessments, targeted literature reviews, or based on authors' clinical experience where data were unavailable. Active treatment (drug acquisition, administration, adverse event and monitoring for several treatment lines), complication and EOL care costs were included. The model took a UK National Health Service and personal social service perspective. <h3>Results</h3> The average, undiscounted, per patient cost of treating myeloma (across all routes) was estimated at £168,000. The average per patient cost associated with EP (£174,987) was higher than for other routes (£151,370–£170,371). Complication and EOL care costs were higher for EP (£56,091) than other routes (£36,987–£49,844). Active treatment at diagnosis comprised 94% of total treatment costs for EP, versus 64–78% for other routes. For EP, 5% of total treatment costs were attributed to patients who received initial observation, but progressed to active disease and received treatment, whilst for other routes this ranged from 20–35%. In the absence of data, active treatment was modelled identically for patients receiving active treatment at diagnosis or after initial observation, thus total treatment costs were similar across routes. Should initial observation impact subsequent active treatment (e.g. duration of treatment-free intervals), total treatment costs may differ between EP and other routes. <h3>Conclusions</h3> An economic benefit may be associated with earlier diagnosis, gained via reduced complication and EOL care costs, with a difference of £19,104 per patient observed between EP and the GP routine route. The impact of initial observation on subsequent active treatment remains a key data gap. <h3>Acknowledgements</h3> This research was conducted free-of-charge on a pro bono basis by Costello Medical.

Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway

BackgroundInternational differences in survival among colorectal cancer (CRC) patients may partly be explained by differences in emergency presentations (EP), waiting times and access to treatment.MethodsCRC patients registered in 2015–2016 at the Cancer Registry of Norway were linked with the Norwegian Patient Registry and Statistics Norway. Multivariable logistic regressions analysed the odds of an EP and access to surgery, radiotherapy and systemic anticancer treatment (SACT). Multivariable quantile regression analysed time from diagnosis to treatment.ResultsOf 8216 CRC patients 29.2% had an EP before diagnosis, of which 81.4% were admitted to hospital with a malignancy-related condition. Higher age, more advanced stage, more comorbidities and colon cancer were associated with increased odds of an EP (p < 0.001). One-year mortality was 87% higher among EP patients (HR=1.87, 95%CI:1.75–2.02). Being married or high income was associated with 30% reduced odds of an EP (p < 0.001). Older age was significantly associated with increased waiting time to treatment (p < 0.001). Region of residence was significantly associated with waiting time and access to treatment (p < 0.001). Male (OR = 1.30, 95%CI:1.03,1.64) or married (OR = 1.39, 95%CI:1.09,1.77) colon cancer patients had an increased odds of SACT. High income rectal cancer patients had an increased odds (OR = 1.48, 95%CI:1.03,2.13) of surgery.ConclusionPatients who were older, with advanced disease or more comorbidities were more likely to have an emergency-onset diagnosis and less likely to receive treatment. Income was not associated with waiting time or access to treatment among CRC patients, but was associated with the likelihood of surgery among rectal cancer patients.

Factors associated with emergency-related diagnosis, time to treatment and type of treatment in 5713 lung cancer patients.

BackgroundInternational and national differences exist in survival among lung cancer patients. Possible explanations include varying proportions of emergency presentations (EPs), unwanted differences in waiting time to treatment and unequal access to treatment.MethodsCase-mix-adjusted multivariable logistic regressions the odds of EP and access to surgery, radiotherapy and systemic anticancer treatment (SACT). Multivariable quantile regression analyzed time from diagnosis to first treatment.ResultsOf 5713 lung cancer patients diagnosed in Norway in 2015–16, 37.9% (n = 2164) had an EP before diagnosis. Higher age, more advanced stage and more comorbidities were associated with increasing odds of having an EP (P < 0.001) and a lower odds of receiving any treatment (P < 0.001). After adjusting for case-mix, waiting times to curative radiotherapy and SACT were 12.1 days longer [95% confidence interval (CI): 10.2, 14.0] and 5.6 days shorter (95% CI: −7.3, −3.9), respectively, compared with waiting time to surgery. Patients with regional disease experienced a 4.7-day shorter (Coeff: −4.7, 95% CI:−9.4, 0.0) waiting time to curative radiotherapy when compared with patients with localized disease. Patients with a high income had a 22% reduced odds [odds ratio (OR) = 0.78, 95% CI: 0.63, 0.97] of having an EP, and a 63% (OR = 1.63, 95% CI: 1.20, 2.21) and a 40% (OR = 1.40, 95% CI: 1.12, 1.76) increased odds of receiving surgery and SACT, respectively.ConclusionPatients who were older, had advanced disease or increased comorbidities were more likely to have an EP and less likely to receive treatment. While income did not affect the waiting time for lung cancer treatment in Norway, it did affect the likelihood of receiving surgery and SACT.

Exploring socioeconomic differences in surgery and in time to elective surgery for colon cancer in England: Population-based study

BackgroundA persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential surgical care by SES. MethodsWe analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010–2013). We examined patterns of presentation and surgery by SES, and whether socioeconomic differences exist in the length of time from diagnosis to elective major resection using linear regression. ResultsAmong a total of 68 169 patients with colon cancer, 21.0 % (3138/14 917) in the most affluent group had emergency presentation (EP) whereas 27.9 % (2901/10 386) in the most deprived. Among 45 332 (66.5 %) patients who underwent resection, the proportion of patients receiving urgent surgery (surgery before or ≤ 7 days of diagnosis) was higher in the most deprived group (39.9 %, 2685/6733) than the most affluent (35.4 %, 3595/10 146). Days from diagnosis to elective surgery (surgery > 7 days after diagnosis) ranged from 33.9 (95 % CI 33.1–34.8) in stage II to 38.2 (95 % CI 36.8–39.7) in stage I, but no socioeconomic differences in time were seen in all stages. ConclusionsTime to elective surgery for colon cancer did not differ by SES, whereas a higher proportion among deprived patients tended to be diagnosed through EP and to receive urgent surgery. These results suggest that the waiting time target may not be an appropriate measure to assess access to cancer care. Reducing both EP and urgent surgery should be a key policy target.

1656P - Acute diagnostic oncology clinic: A unique primary care-oncology service

BackgroundCancers presenting with ‘vague symptoms’ are difficult to diagnose. These non-specific but serious symptoms (weight loss, anorexia, pain, fatigue) have a number of causes including malignancy. The risk for each individual cancer may be low, but the total risk of cancer of any type is higher. Patients diagnosed with cancer as the result of an emergency presentation (EP) to secondary care have poorer survival, usually describe a long history of symptoms, and most have seen their general practitioner (GP) prior to presentation. Earlier diagnosis improves cancer outcomes. But investigating vague symptoms is challenging, requiring both oncology and general medical knowledge, while bespoke rapid-access oncology diagnostic clinics are needed to avoid EP. MethodsThe Acute Diagnostic Oncology Clinic was established at Chelsea & Westminster Hospital in 2016. It initially provided rapid access investigations for those too ill to wait for an urgent suspected cancer appointment, as an alternative to the Emergency Department (ED). In February 2018 the clinic expanded to, uniquely, include a GP with specialist interest in oncology and patients with ‘vague symptoms’. Results361 referrals were received, 65% were female. Weight loss was the commonest vague symptom (50%). Initially, 96% of patients were seen within 24hours of referral, falling to 69% after expansion of the clinic remit in 2018. 34% of patients (from 2018, 21%) were diagnosed with cancer. Mean time from referral to diagnosis was 4 days, and to starting cancer treatment it was 20 days. A range of cancers were identified, lung the commonest, and advanced stage disease the most likely. A number of significant non-malignant conditions were diagnosed. One-third of patients provided feedback. Only 37% were told at referral that cancer was suspected. The service was rated Excellent or Very Good in all cases. 84% valued being seen urgently. Feedback was received from 40 GPs. 100% would use the service again. Alternate referral routes would have been routine cancer referral (60%) or ED (13%). ConclusionsTo our knowledge, this is the only GP-oncology led rapid access cancer diagnostic clinic. Combining general medical and oncology expertise is an effective approach for diagnosing patients with vague symptoms and tackling EP cancer. Legal entity responsible for the studyThe authors. FundingCW+ Healthcare Charity. DisclosureAll authors have declared no conflicts of interest.

Contrasting effects of comorbidities on emergency colon cancer diagnosis: a longitudinal data-linkage study in England

BackgroundOne in three colon cancers are diagnosed as an emergency, which is associated with worse cancer outcomes. Chronic conditions (comorbidities) affect large proportions of adults and they might influence the risk of emergency presentations (EP).MethodsWe aimed to evaluate the effect of specific pre-existing comorbidities on the risk of colon cancer being diagnosed following an EP rather than through non-emergency routes. The cohort study included 5745 colon cancer patients diagnosed in England 2005–2010, with individually-linked cancer registry, primary and secondary care data. In addition to multivariable analyses we also used potential-outcomes methods.ResultsColon cancer patients with comorbidities consulted their GP more frequently with cancer symptoms during the pre-diagnostic year, compared with non-comorbid cancer patients. EP occurred more frequently in patients with ‘serious’ or complex comorbidities (diabetes, cardiac and respiratory diseases) diagnosed/treated in hospital during the years pre-cancer diagnosis (43% EP in comorbid versus 27% in non-comorbid individuals; multivariable analysis Odds Ratio (OR), controlling for socio-demographic factors and symptoms: men OR = 2.40; 95% CI 2.0–2.9 and women OR = 1.98; 95% CI 1.6–2.4. Among women younger than 60, gynaecological (OR = 3.41; 95% CI 1.2–9.9) or recent onset gastro-intestinal conditions (OR = 2.84; 95% CI 1.1–7.7) increased the risk of EP. In contrast, primary care visits for hypertension monitoring decreased EPs for both genders.ConclusionsPatients with comorbidities have a greater risk of being diagnosed with cancer as an emergency, although they consult more frequently with cancer symptoms during the year pre-cancer diagnosis. This suggests that comorbidities may interfere with diagnostic reasoning or investigations due to ‘competing demands’ or because they provide ‘alternative explanations’. In contrast, the management of chronic risk factors such as hypertension may offer opportunities for earlier diagnosis. Interventions are needed to support the diagnostic process in comorbid patients. Appropriate guidelines and diagnostic services to support the evaluation of new or changing symptoms in comorbid patients may be useful.

Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses.

ObjectivesTo identify opportunities for reducing emergency colon cancer diagnoses, we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP).MethodsCohort of 5,745 colon cancers diagnosed in England 2005–2010, with individually linked cancer registry and primary care data for the 5‐year pre‐diagnostic period.ResultsColon cancer was diagnosed following EP in 34% of women and 30% of men. Among emergency presenters, 20% of women and 15% of men (p = 0.002) had alarm symptoms (anaemia/rectal bleeding/change in bowel habit) 2–12 months pre‐diagnosis. Women with abdominal symptoms (change in bowel habit/constipation/diarrhoea) received a benign diagnosis (irritable bowel syndrome (IBS)/diverticular disease) more frequently than men in the year before EP: 12% vs. 6% among women and men (p = 0.002). EP was more likely in women (OR = 1.20; 95% CI 1.1–1.4), independently of socio‐demographic factors and symptoms. Benign diagnoses in the pre‐diagnostic year (OR = 2.01; 95% CI 1.2–3.3) and anaemia 2–5 years pre‐diagnosis (OR = 1.91; 95% CI 1.2–3.0) increased the risk of EP in women but not men. The risk was particularly high for women aged 40–59 with a recent benign diagnosis vs. none (OR = 4.41; 95% CI 1.3–14.9).ConclusionsWomen have an increased risk of EP, in part due to less specific symptoms and their more frequent attribution to benign diagnoses. For women aged 40–59 years with new‐onset IBS/diverticular disease innovative diagnostic strategies are needed, which might include use of quantitative faecal haemoglobin testing (FIT) or other colorectal cancer investigations. One‐fifth of women had alarm symptoms before EP, offering opportunities for earlier diagnosis.

The Route to Diagnosis: Emergency Presentation of Lung Cancer

A significant proportion of lung cancer patients are first diagnosed as part of an emergency presentation (EP) to acute medical services. This route to diagnosis is a strong negative predictor of survival, and is associated with age, deprivation and medical co-morbidities. Patients are less likely to receive anticancer treatment than those diagnosed through elective routes. The causes of EP of cancer are complex. When it is unavoidable, prompt input from specialist lung cancer services is needed. Preventing EP of lung cancer involves streamlined diagnostic pathways, public health campaigns about symptoms, decision-support tools for general practitioners, improved communication and access for primary and secondary care, and focus on vague symptoms. Reducing EP of lung cancer is important when improving outcomes and patient experience.

P1.06-016 Route to Lung Cancer Diagnosis in the UK: How Does This Affect Patient Outcome?

The commonest route to lung cancer diagnosis in the United Kingdom (UK) is via emergency presentations (EP), with 35% of lung cancer diagnoses being made via this route. We aim to study the outcome of patients diagnosed with lung cancer via all routes of presentation and its contributing factors in a UK district general hospital.

PA01.02 The Route to Diagnosis: Impacting Survival by Changing the System

PA01.02 The Route to Diagnosis: Impacting Survival by Changing the System

Emergency diagnosis of lung cancer: An international problem.

6536 Background: Lung cancer survival in the United Kingdom (UK) is lower than similar healthcare systems in Europe. 40% of UK lung cancer patients are first diagnosed with their disease during presentation to emergency or acute medical services. This emergency presentation (EP) is associated with late diagnosis and lower 1-year relative survival. The gatekeeper role of the general practitioner (GP) has been suggested as a possible cause for the high rates of EP in the UK. We investigated whether EP is a feature of other healthcare systems in Europe. Methods: Retrospective data was collected on all lung cancer patients diagnosed in 2012 from 11 hospitals in 8 countries: Austria, Croatia, France, Ireland, Italy, Netherlands, Portugal and UK. Where required, ethical approval was obtained prior to data collection. Results: 2,315 patients were included, of which 534 (23.1%) were diagnosed as part of an emergency presentation. EP rates between counties ranged from 13.2% to 47.7% and did not correlate with whet...