Introduction Survival for lung cancer patients in the UK is worse than in comparable countries, at least partly because they present with more advanced disease.1 Recent data suggest that rural residence is associated with an increased risk of early death in lung cancer.2
As our region encompasses rural areas, we investigated rates of emergency admission at the three major hospitals in our region and factors which may lead to this.
Methods We retrospectively identified new presentations of lung cancer as emergencies from August to October 2014. We gathered patient demographics, mortality and GP presentation data and compared them with local lung cancer database data for the same time period.
Results We identified 41 new lung cancer diagnoses in this period, from a total of 119 new diagnoses. This gives an emergency diagnosis rate of 34.5%, comparable to national figures of 39%.1 However, there was significant variation (21–43%) between the three sites.
When analysed by gender, only 30% of male diagnoses were made at emergency presentation, compared with 41% of females. Unfortunately our sample size was not large enough to demonstrate statistical significance (p = 0.22).
GP data were available for 28 patients, of whom 17 had reported symptoms to their GP. The median duration between first reporting symptoms to the GP and being admitted as an emergency was only 4 days.
As expected, staging in emergency patients was significantly higher than in those diagnosed as outpatients (Figure 1, ✻ indicates p < 0.001). Mortality at 3 months was comparable: 56% compared with 13% (p < 0.001).
Conclusions Emergency presentation data for our region are comparable with national figures, with comparable mortality.
Further examination of variability in admission rates between our hospitals, and possible gender inequality, could suggest future avenues to improve early lung cancer diagnosis.
References 1 Walters S, Maringe C, Coleman MP, et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study 2004-2007. Thorax 2013;68:551–564
2 O’Dowd EL, McKeever TM, Baldwin DR, et al. What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK? Thorax 2015;70:161–168