Introduction The National Cancer Intelligence Network recently published an analysis of 226,000 cases of cancer and showed that 23% of all cancers had an emergency presentation as their “route to diagnosis”. This figure was higher for lung cancer at 38% with an indication that survival is particularly poor for these patients, but the analysis lacked detailed information on other key clinical characteristics. We have used data from the National Lung Cancer Audit to investigate the characteristics of, and outcomes for, patients with emergency presentation.
Methods We obtained data on 100,884 cases of histologically-confirmed or presumed NSCLC and used multivariate logistic regression to quantify the association of emergency presentation, allowing for age at diagnosis, sex, stage, performance status, co-morbidity and socioeconomic status. Survival was calculated using the Kaplan-Meier method and Cox proportional hazards model.
Results 51% were referred by their GP, 21% by another secondary care consultant, 14% following an emergency admission to hospital, 7% following an emergency presentation to A&E and the remaining 7% by other routes.
A binary variable was created by combining those referred following emergency admission or emergency presentation to A&E (‘Acute’) and by combining all other cases (‘Non-Acute’).
Table 1 shows the multivariate odds ratios for acute presentation, demonstrating that higher disease stage and worse performance status are characteristics most associated with an acute presentation.
At 1 year, there were 17,165 deaths in the acute group, leaving 16.3% still alive (median survival 77 days), compared to 49,177 deaths in the non-acute group, leaving 38.8% still alive (median survival 259 days). The unadjusted hazard ratio for death at 1 year in those with an emergency presentation was 2.2 (95% CI 2.16–2.24, p<0.001), and after adjustment for age, sex, stage, performance status, co-morbidity and socioeconomic status, the corresponding value was 1.56 (95% CI 1.53–1.60, p<0.001).
Conclusions Emergency presentations are associated with poorer outcomes, but they also consume large amounts of healthcare spending which could be better utilised in a rapid and efficient referral and diagnostic pathway. Efforts to better understand the gaps in current service provision that allow so many patients to present so late are long overdue.
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