Predictors and consequences of different pathways to emergency diagnosis of cancer in England: Evidence from linked national audit and cancer registration data

Abstract

Background: Diagnosis of cancer soon after emergency care use is associated with adverse prognosis. We aimed to more precisely explore different definitions of emergency diagnosis.

Methods: For 43,383 patients in the National Cancer Diagnosis Audit and Routes to Diagnosis datasets, we defined two emergency care pathways: emergency referral (Type-A) and emergency hospital admission (Type-B). We examined patient and tumour factors associated with each pathway excluding the other, and in combination (Type-A+B), in particular their concordance and prognostic implications for short-term mortality.

Results: One in five patients (19 %) were diagnosed following emergency care use: 4 % through Type-A only, 7 % through Type-B only, and 8 % through Type-A+B. Higher co-morbidity, deprivation, advanced stage and certain cancer sites were associated with greater risk of emergency diagnosis. Concordance of emergency diagnosis pathway between Type-A and Type-B increased with age, co-morbidity and certain cancer sites. Patients with non-alarm symptoms were more likely to self-refer (Type-A) to an Emergency Department than patients with alarm symptoms. Associations with higher short-term mortality were strongest for Type-A+B.

Conclusions: We profile different pathways to emergency diagnosis and identify opportunities to improve diagnostic processes for these patients.

Keywords: Audit; Cancer; Emergency diagnosis; Mortality; Primary care.