Abstract
Background:
People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand.
Methods:
Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation. Qualitative context coding of primary care interaction before emergency presentation.
Results:
Emergency presentations equalled 20% (n=365). Twenty-eight per cent had no relevant prior GP contact. Of those with prior GP contact 30% were admitted while waiting to be seen in secondary care, and 19% were missed opportunities for earlier diagnosis. Associated predictors: no prior GP contact (OR=3.89; CI 95% 2.14–7.09); having lung (OR=23.24; 95% CI 7.92–68.21), colorectal (OR=18.49; CI 95% 6.60–51.82) and upper GI cancer (OR=18.97; CI 95% 6.08–59.23); ethnicity (OR=2.78; CI 95% 1.27–6.06).
Conclusions:
Our novel approach has revealed that emergency cancer presentation is more complex than previously thought. Patient delay, prolonged referral pathways and missed opportunities by GPs all contribute, but emergency presentation can also represent effective care. Resources should be used proportionately to raise public and GP awareness and improve post-referral pathways.
People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand.
Methods:
Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation. Qualitative context coding of primary care interaction before emergency presentation.
Results:
Emergency presentations equalled 20% (n=365). Twenty-eight per cent had no relevant prior GP contact. Of those with prior GP contact 30% were admitted while waiting to be seen in secondary care, and 19% were missed opportunities for earlier diagnosis. Associated predictors: no prior GP contact (OR=3.89; CI 95% 2.14–7.09); having lung (OR=23.24; 95% CI 7.92–68.21), colorectal (OR=18.49; CI 95% 6.60–51.82) and upper GI cancer (OR=18.97; CI 95% 6.08–59.23); ethnicity (OR=2.78; CI 95% 1.27–6.06).
Conclusions:
Our novel approach has revealed that emergency cancer presentation is more complex than previously thought. Patient delay, prolonged referral pathways and missed opportunities by GPs all contribute, but emergency presentation can also represent effective care. Resources should be used proportionately to raise public and GP awareness and improve post-referral pathways.
Original language | English |
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Pages (from-to) | 1148-1158 |
Number of pages | 11 |
Journal | British Journal of Cancer |
Volume | 116 |
Issue number | 9 |
Early online date | 23 Mar 2017 |
DOIs | |
Publication status | Published - 25 Apr 2017 |
Bibliographical note
The study was funded by the Chief Scientist’s Office of the Scottish Government.Twelve months after publication in British Journal of Cancer, the Contribution, as published on the BJC website, will be offered for reuse under the terms of the Creative Commons Attribution-NonCommercial-Share-Alike 3.0 licence
Keywords
- emergency presentation
- emergency diagnosis
- cancer type
- route to diagnosis
- age
- sex
- deprivation
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Rosalind Adam
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Senior Clinical Lecturer
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cancer Centre
Person: Clinical Academic
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Amanda Lee
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Medical Statistics
- Institute of Applied Health Sciences
- School of Medicine, Medical Sciences & Nutrition, Medical Statistics
Person: Academic
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Peter Murchie, BSc (Med Sci), MBChB, MSc, MRCGP, CertMgmt (Open), PhD
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Personal Chair (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic