Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data

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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.
Original languageEnglish
Pages (from-to)1148-1158
Number of pages11
JournalBritish Journal of Cancer
Volume116
Issue number9
Early online date23 Mar 2017
DOIs
Publication statusPublished - 25 Apr 2017

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Secondary Care
Primary Health Care
Emergencies
Odds Ratio
Confidence Intervals
Neoplasms
Early Diagnosis
Referral and Consultation
Scotland
General Practitioners
Lung
Survival

Keywords

  • emergency presentation
  • emergency diagnosis
  • cancer type
  • route to diagnosis
  • age
  • sex
  • deprivation

Cite this

@article{ca707fe1ee414fc7a102d30e3fd5e99a,
title = "Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data",
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.",
keywords = "emergency presentation, emergency diagnosis, cancer type, route to diagnosis, age, sex, deprivation",
author = "Peter Murchie and Sarah Smith and Michael Yule and Rosalind Adam and Turner, {Melanie E} and Lee, {Amanda J} and Shona Fielding",
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",
year = "2017",
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doi = "10.1038/bjc.2017.71",
language = "English",
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journal = "British Journal of Cancer",
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T1 - Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data

AU - Murchie, Peter

AU - Smith, Sarah

AU - Yule, Michael

AU - Adam, Rosalind

AU - Turner, Melanie E

AU - Lee, Amanda J

AU - Fielding, Shona

N1 - 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

PY - 2017/4/25

Y1 - 2017/4/25

N2 - 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.

AB - 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.

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KW - cancer type

KW - route to diagnosis

KW - age

KW - sex

KW - deprivation

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SN - 0007-0920

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