Diagnosis of cancer as a medical emergency leads to poorer prognosis for many patients

cjb250 — Tue, 11 Oct 2016 11:00:55 +0000

In an article in the journal Nature Reviews Clinical Oncology, a team of researchers jointly led by the ̽��ֱ�� of Cambridge and ̽��ֱ�� College London reviewed current evidence from 26 peer-reviewed studies and 6 online reports from 7 countries. ̽��ֱ��evidence indicates that emergency diagnosis of cancer is a universal problem, challenging previous assumptions regarding this issue being a particular problem only in the UK.

Looking at prognosis alone, the researchers reviewed evidence that showed that patients diagnosed with colorectal cancer at emergency presentation had a 50% one year survival rate, compared to 82% for patients diagnosed electively - in other words, following a GP referral to a specialist. Similarly, for lung cancer the respective survival rates were 12% versus 40%. This was in part because cancer diagnosed at emergency care was more likely to be at an advanced stage. However, this was not the full story: even when patients presented with tumours of the same disease stage they still had a worse prognosis if they were diagnosed in emergency care, possibly because of problems in the quality of their management out-of-hours, or because they have more aggressive disease on a stage-for-stage basis.

In the UK, about three in 10 emergency presenters are referred to hospital emergency services by their family doctors, but others self-present to accident and emergency departments. Patients at both ends of the age spectrum – the youngest and the oldest – were most likely to have their cancer diagnosed in emergency contexts. Differences between genders were unclear – and vary for different types of cancer.

However, the review found particular inequalities between socioeconomic groups. Although the evidence came only from studies looking at colorectal and lung cancer, it found that people from more deprived backgrounds were at a greater risk of being diagnosed at emergency care. ̽��ֱ��same was true for people of Asian ethnicity in the UK and African-Americans in the USA.

First author Dr Yin Zhou from the Primary Care Unit at the ̽��ֱ�� of Cambridge, who led the study, says: " ̽��ֱ��earlier an individual can get a diagnosis of cancer, the better the prognosis and the options for treatment. When the first time their cancer is identified is when it becomes an emergency, the prognosis is much worse.”

Dr Georgios Lyratzopoulos, who instigated and coordinated the collaboration, based at the Department of Epidemiology and Public Health, ̽��ֱ�� College London adds: "A substantial minority of cancer patients who are diagnosed as emergencies do not seem to have had prior contact with the formal healthcare system; we need to find out why they are not seeking medical help sooner. Is it because they are unaware of any symptoms until too late, or is it because they do not think the symptoms are a sign of a more serious problem?"

̽��ֱ��researchers found that the evidence points towards developing new screening methods and improving participation in existing screening programme as one possible way to reduce emergency presentations in the medium to longer term. For example, based on indirect evidence in one geographical region in the UK, the introduction of faecal occult blood test in the UK is likely to have reduced the proportion of patients with colorectal cancer diagnosed as emergencies by half between 1999 and 2004.

"What was clear from our review," adds Dr Zhou, "is how little data there is available about emergency diagnoses. What little data there is suggests that we're only seeing the tip of the iceberg and that this could be a much bigger problem, particularly in low and middle income countries."

A major part of the global evidence on emergency presentations (in terms of patient numbers) relates to English patients – thanks to the pioneering Routes to Diagnosis project and population-based data collected by the National Cancer Registration and Analysis Services of Public Health England.

Dr Anne Mackie, Director of Screening at Public Health England, said: “Screening has a vital role to play in identifying cancers at an early stage and getting people the right treatment as soon as possible, with better survival chances. Screening is always the person’s own choice and they should speak to their GP if they have any questions before deciding if screening is right for them.”

Reference
Zhou, Y et al. Diagnosis of cancer as an emergency: a critical review of current evidence. Nature Reviews Clinical Oncology; 11 Oct 2016; 10.1038/nrclinonc.2016.155

Too many patients – particularly those from disadvantaged backgrounds – are being diagnosed with cancer as medical emergencies, say researchers. This means that their chances of successful treatment are greatly reduced.

̽��ֱ��earlier an individual can get a diagnosis of cancer, the better the prognosis and the options for treatment. When the first time their cancer is identified is when it becomes an emergency, the prognosis is much worse

Yin Zhou

Lydia

Accident & Emergency Sign

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes

Licence type:

Attribution

Improving access to GP surgeries could reduce burden on out-of-hours services

cjb250 — Wed, 21 May 2014 22:30:00 +0000

Out-of-hours primary care services – such as a telephone consultation followed by a home visit or attendance at an out-of-hours centre – present several disadvantages compared to in-hours services. Not only are these services more expensive to the NHS, but maintaining the high standards of care and patient experience out-of-hours is challenging. In part this is because patients using out-of-hours services will often be seen by doctors unfamiliar with their potentially complex case histories. For these reasons, modern healthcare systems aim to reduce demand for out-of-hours primary care.

In a study published in the Emergency Medicine Journal, researchers from the ̽��ֱ�� of Cambridge and the ̽��ֱ�� of Exeter Medical School analysed data from almost 570,000 respondents to the 2011/2012 English General Practice Patient Survey to see why people used out-of-hours services and to identify ways of reducing this burden.

̽��ֱ��researchers found that a proportion of patients faced a number of potential barriers to accessing GP surgeries including an ability to get through to the surgery on the telephone or to get an appointment, urgent or otherwise, as well as inconvenient opening hours. ̽��ֱ��patients who experience these difficulties have a higher chance of resorting to the use of out-of-hours primary care services.

7.5% of respondents reported using out-of-hours services in the previous six months though not all of these were due to difficulties in accessing regular GP services. ̽��ֱ��researchers estimate that optimising access to in-hours services would reduce this to 6.7%, a relative reduction of 11%.

Dr Yin Zhou from the Cambridge Centre for Health Services Research says: “ ̽��ֱ��use of out-of-hours services is not ideal for the patient and can be costly to the NHS. If we’re to reduce the burden on the NHS and improve patient care, then we need to make improvements in providing access to GP surgeries.”

Contrary to expectations, the researchers found that the association between out-of-hours use and the convenience of surgery opening hours was stronger amongst people in part-time than those in full-time work or education. In other words, even when opening hours suited people in part-time work, they were more likely to attend out-of-hours services than those in full-time work or education.

Professor Martin Roland, Director of the Centre, adds: “Our research suggests that improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour. Even those in part-time work can struggle to get an appointment, so offering greater availability during regular surgery hours would help reduce use of out-of-hours services.”

̽��ֱ��study was funded by the East of England Multi-Professional Deanery, the Department of Health and the National Institute of Health Research.

Poor access to GP surgeries could be driving patients to use out-of-hours services and putting an extra burden on the NHS, according to researchers at the Cambridge Centre for Health Services Research. In research published today, they say that improving access could lead to an 11% reduction in the use of out-of-hours primary care services.

Improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour

Martin Roland

Julian Claxton Photography, Wellcome Images

GP consultation with a female patient

̽��ֱ��text in this work is licensed under a Creative Commons Licence. If you use this content on your site please link back to this page. For image rights, please see the credits associated with each individual image.

Yes

Licence type:

Attribution-Noncommerical

̽��ֱ�� of Cambridge - Yin Zhou

Diagnosis of cancer as a medical emergency leads to poorer prognosis for many patients

Improving access to GP surgeries could reduce burden on out-of-hours services