Worrying number of cancer patients in UK diagnosed through emergency routes

More cancers are being diagnosed through emergency routes in the UK than in comparable high-income countries, according to new analysis by the International Cancer Benchmarking Partnership (ICBP), which is hosted by Cancer Research UK.  

In the first study of its kind*, researchers at University College London found that, for eight major cancer sites between 2012 and 2017, over a third of patients in England (37%)**, Wales (37.4%) and Scotland (38.5%) were diagnosed after being rushed into hospital. In Northern Ireland, which was measured using a different definition, emergency presentations accounted for over a quarter (27.9%) of diagnoses***. 

This is the first time we have seen figures for the UK nations alongside data from comparable countries and the charity is now calling for government to act on this worrying picture.  England, Scotland and Wales lagged behind Australia and Canada, and was similar to Norway – with New Zealand having the highest levels of emergency presentations****.  

The study, published in The Lancet Oncology, looked at 857,068 cancer cases diagnosed between 2012 and 2017, in six comparable countries (Australia, Canada, Denmark, New Zealand, Norway and the UK). Cancer types included were oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancers.  

The proportion of emergency presentations ranged from 42.5% in New Zealand to 24% in the Australian state of Victoria – indicating a global problem.  

Older patients and those with advanced cancer were most likely to be diagnosed through an emergency route – as were cancers with often non-specific, vague symptoms, such as pancreatic, liver, lung, and ovarian.  

The study also found that countries with higher levels of emergency presentations had poorer survival. For every 10% increase in emergency presentations in the studied countries, there was a decrease in one-year survival for six of the eight cancer types***** – ranging from 2.5% for ovarian cancer to 7% for colon cancer.    

And experts are worried that COVID-19 has exacerbated the situation. Fewer people coming forward with symptoms and reduced access to cancer tests mean the number of emergency presentations are expected to have increased. 

The researchers highlight the need for better symptom awareness, reduced barriers to cancer screening – particularly for bowel cancer – and additional diagnostic capacity to improve the early diagnosis of cancer. They also encouraged better monitoring of emergency presentations across participating countries******.  

Professor Georgios Lyratzopoulos, lead researcher from University College London, said: “This is the first population-based study to ever look at diagnoses of cancer through emergency presentations internationally and to examine their link to survival. It has given us valuable insights into which patients and cancers are more likely to be diagnosed after an emergency hospital admission. Vulnerable patients – those who are older or with advanced disease – are disproportionately affected around the world. 

“The data tell us that emergency presentations are a global problem – and not concentrated in a single country or health system. Getting better at preventing cancer, detecting it through screening, or diagnosing it soon after symptoms appear can help decrease emergency presentations and reduce cancer deaths. This message applies to Canada, Europe and Oceania, as well as the UK.” 

Michelle Mitchell, Cancer Research UK’s chief executive, said: “For months we have been warning that cancer survival could go backwards due to the pandemic. The UK is already lagging when it comes to cancer survival – this study helps us understand why, showing that countries with higher levels of emergency presentations have lower survival. If we want to build a world-class cancer service, we need to learn from comparable countries and ensure fewer patients are being diagnosed with cancer after an emergency referral or trip to A&E.  

“We’d like to see governments across the UK take bold action on this within their cancer plans – so that by 2032, fewer than 10% of cancer cases are diagnosed through emergency routes.” 

Dr John Butler, clinical lead for the International Cancer Benchmarking Partnership and an ovarian cancer surgeon, said: “Cancers diagnosed through emergency routes are often more advanced than those caught after GP referral or through screening. This can affect a someone’s chances of surviving cancer, and affects the type of treatment they’re offered. Unfortunately, I often see this with ovarian cancer, where around a third of patients are diagnosed after being admitted to hospital. 

“Across the globe, the pandemic has challenged healthcare systems. In the UK, access to primary care and diagnostic tests were reduced and screening paused. This means some cancers, especially those with vague, non-specific symptoms, may have gone unnoticed. Cancer plans across the UK must prioritise early diagnosis. To have a better chance of beating their cancer, people must be treated as soon as possible." 

ENDS  

For media enquiries contact Michelle Ferguson in the Cancer Research UK press office on 020 3469 6183 or, out of hours, on 0203 469 8301.  

Notes to editor:  

* McPhail S et al. Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study. Lancet Oncol 2022; Published Online April 6, 2022 https://doi.org/10.1016/ S1470-2045(22)00127-9 

Once the paper has been published online, it will be available at the following URL: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00127-9/fulltext 

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data are collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS Digital. 

** England and Northern Ireland have published data on Routes to Diagnosis separately. These may vary from the figures published in this research due to differences in data sources, date ranges used, and the cancer sites included. For England, the latest data show that, in 2018, 18% of all cancer cases (excluding non-melanoma skin cancer) were diagnosed through emergency routes. For Northern Ireland, the latest data show that, between 2012-2016, 20% of all cancer cases (excluding non-melanoma skin cancer) were diagnosed through emergency presentation. 

Data Sources:  

NHS Digital (2022) Routes to Diagnosis, 2018 

HSC Business Services Organisation (2020) Pathways to a cancer diagnosis: monitoring variation in the patient journey across Northern Ireland 2012-2016  

*** Emergency presentations were defined in two different ways – broad and narrow – and the definition used varied between UK nations. Scotland, Wales used a ‘broad’ definition – emergency hospital admission in the 30 days before the date of cancer diagnosis. Northern Ireland used a ‘narrow’ definition – additionally requiring that emergency hospitalisations occurred without an intervening elective (non-emergency) admission. England was measured using both definitions. The researchers report that using a broad definition ‘uplifts’ the level of emergency presentations substantially – in the range of 4% to 6% – so comparisons across countries, particularly when using different definitions, should be avoided. For example, when using a broad definition emergency presentation account for 37% of diagnoses in England versus 31.3% when using a narrower definition. 

*** Table 1. Proportion of Emergency Presentations (%) by jurisdiction and cancer type 

1 England and New South Wales was measured using both the ‘broad’ and ‘narrow’ definitions. 

***** Unlike for stomach, colon, liver, pancreatic, lung and ovarian cancers, no link was found between higher levels of emergency presentations within a country and survival for oesophageal and rectal cancers. 

****** Unlike other cancer statistics, such as incidence, mortality and survival, diagnostic route information (emergency presentation, GP referral or screening) is not widely used across the world. In England, emergency presentations are routinely monitored, and researchers are advocating for wider use of this measure in official cancer surveillance statistics globally. 

About Cancer Research UK 

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About the International Cancer Benchmarking Partnership (ICBP)  

The International Cancer Benchmarking Partnership (ICBP) is a unique and innovative global partnership of clinicians, academics, policymakers and data experts. It produces high quality research to help identify best international practice, and generate insights needed for policy and practice change. The ICBP is funded by the partners representing each jurisdiction. The programme management team are hosted by Cancer Research UK. www.icbp.org.uk  

Funders: Canadian Partnership Against Cancer, Cancer Council Victoria, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, DG Health and Social Care, Scottish Government, National Cancer Registry Ireland, National Health Service England, Norwegian Cancer Society, Public Health Agency Northern Ireland on behalf of the Northern Ireland Cancer Registry, Public Health Wales NHS Trust, The Cancer Society of New Zealand, Western Australia Department of Health