More patients are diagnosed with cancer in A&E in Britain than in other comparable high-income countries, according to the first major study of its kind.
More than a third of patients in England, Scotland and Wales only find out they have the disease once they are in hospital, the research published in the Lancet Oncology journal suggests. People who end up in A&E, sometimes after multiple trips to their GP, are less likely to survive the disease, particularly if they have stomach, bowel, liver, pancreatic, lung or ovarian cancer.
The International Cancer Benchmarking Partnership and Cancer Research UK (CRUK) examined cancer data and linked hospital admissions across 14 regions in six countries: Australia, Canada, Denmark, New Zealand, Norway and the UK.
Cancer data often has a time lag – the data was collected between 2012 and 2017 – but CRUK said it feared the outlook is now even worse after the Covid-19 pandemic.
Experts at University College London looked at eight major cancers and found that more than a third of patients in England (37%), Wales (37%) and Scotland (39%) were diagnosed after being rushed to hospital. In Northern Ireland, which was measured using a different definition, emergency presentations accounted for more than a quarter (28%) of diagnoses.
England, Wales and Scotland ranked worse than all other regions and countries in the study except New Zealand, where the rate was 43%. The lowest rate recorded was 24% in Victoria, Australia.
“For months, we have been warning that cancer survival could go backwards due to the pandemic,” said Michelle Mitchell, CRUK’s chief executive. “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.”
She added: “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.”
When it comes to specific cancers, 46% of people with pancreatic cancer were diagnosed in an emergency overall, but the figure was much higher in Britain, at 56% in England and Wales and 59% in Scotland. In New Zealand, 60% of patients were diagnosed with pancreatic cancer in an emergency and in Norway it was 55%. However, the figures for Ontario and Alberta, both in Canada, were 35% and 41% respectively.
A total of 34% of people in England and Wales and 35% in Scotland were diagnosed with bowel cancer in an emergency, but the figure was 27% in Ontario and 32% in New South Wales in Australia.
Meanwhile, 47% of people in the UK were diagnosed with liver cancer in an emergency, compared with 40% in New South Wales, 32% in Alberta and 28% in Ontario. In Norway the figure was 51%.
The study found that those aged 75 and over were more likely to be diagnosed in an emergency, as were those whose cancer was advanced. Emergency diagnoses also resulted in a twofold higher risk of dying in the next 12 months compared with people who were diagnosed at other times.
Cancers that often had non-specific, vague symptoms, such as pancreatic, liver, lung and ovarian cancer, were also more likely to be diagnosed in A&E.
