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Abstract
Introduction Nationally it is known that 23% of all cancers present as emergencies.1 Baseline data for all cancer-related admissions for 2008/2009 in the Trust demonstrated that patients with lung cancer had both the highest rate of unscheduled admissions and the greatest number of inpatient bed days compared with other cancer sites. In 2010, there were 220 new cases of lung cancer diagnosed across the Trust. We reviewed the records of all patients admitted to the Trust with a coded diagnosis of lung cancer retrospectively. This did not include those patients seen in A&E and discharged. Cases were recorded as known (diagnosed prior to that admission and known to the service), or new (diagnosed on or as a result of that admission).
Results In 2010 there were 110 admissions overall with lung cancer. 34 patients (16.4%) had their lung cancer diagnosed as a consequence of that admission. 26/34 (76%) presented on the general medical take; the remainder to Care of the Elderly team as they were ≥80. At diagnosis, the majority were ECOG performance status 3/4, thereby precluding any active cancer treatment. 29 patients (85%) were diagnosed with metastatic disease at presentation. One quarter of those diagnosed on that admission died, with a median survival of 8 days. The mortality at 30 days was 50%; 23/34 (68%) had died within 6 months of the admission. Only two patients (6%) survived 1 year. Access to specialist palliative care and palliative treatments such as radiotherapy/chemotherapy/stent insertion was good.
Conclusions Patients diagnosed on an acute admission with lung cancer generally present with advanced disease and poor performance status. Treatment options are limited and the overall survival is very poor. This leaves little time for patients and their families to come to terms with their condition and affects where patients may die. This data has been used to inform local awareness projects in both the primary and secondary care community. As a result, a novel rapid access clinic has been established for newly presenting patients to enable swift diagnosis and where possible an alternative to admission.
