In an International Cancer Benchmarking Partnership study reported in The Lancet Oncology, McPhail et al identified the proportions of cancer diagnoses made within 30 days after emergency presentation and hospital admission. They also analyzed risk factors and outcomes for such diagnoses in a group of high-income countries.
Study Details
The study involved data from 14 jurisdictions in Australia, Canada, Denmark, New Zealand, Norway, and the United Kingdom on patients with primary diagnoses of invasive esophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during a study period from January 2012 to December 2017. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission.
Key Findings
Among 857,068 patients in the 14 jurisdictions, the percentage of diagnoses through emergency presentation including all eight cancer sites ranged from 24.0% (9,165 of 38,212 patients) to 42.5% (12,238 of 28,794 patients) across jurisdictions.
Variations in the percentages of emergency presentations by cancer site and jurisdictions were observed. Pancreatic cancer diagnoses had the highest percentage of emergency presentations overall (46.1%; 30,972 of 67,173 patients), with a range among jurisdictions of 34.1% (1,083 of 3,172 patients) to 60.4% (1,317 of 2,182 patients). Rectal cancer had the lowest percentage of emergency presentations overall (12.1%; 10,051 of 83,325 patients), with a range among jurisdictions of 9.1% (403 of 4,438 patients) to 19.8% (643 of 3,247 patients).
Older age and more advanced disease at diagnosis were consistently associated with increased risk of emergency presentation leading to diagnosis. For 110 (98%) of 112 jurisdiction-cancer site strata (8 cancer sites, 14 jurisdictions), the percentage of emergency presentations was greatest in the ≥ 85 years age group. For colon and stomach cancer, a J-shaped pattern by age was observed in most jurisdictions, in which patients aged 15 to 64 had a higher percentage of emergency presentations than patients aged 65 to 74. For 98 (97%) of 101 jurisdiction-cancer site strata with available data, the percentage of emergency presentations was greatest among patients with the most advanced stage of cancer at diagnosis.
Patients diagnosed through emergency presentation had a significantly elevated risk of 12-month mortality vs patients diagnosed through nonemergency presentation in all 112 (100%) jurisdiction-cancer site strata, with all odds ratios > 1.9 and a lowest 95% confidence interval lower bound of 1.26. In adjusted analysis in 12 jurisdictions with complete data on disease stage, odds ratios for 12-month mortality ranged from 2.62 to 3.53.
Negative associations between jurisdiction-level percentage of emergency presentations and 12-month survival were observed, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 12-month net survival of 7% for colon, 5.6% for stomach, 4.2% for lung, 4.2% for liver, 3.6% for pancreatic, and 2.5% for ovarian cancer.
The investigators concluded, “Internationally, notable proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts worse prognosis and probably contributes to international differences in cancer survival. Monitoring emergency presentations and identifying and acting on contributing behavioural and health-care factors is a global priority for cancer control.”
Georgios Lyratzopoulos, MD, of the Institute of Epidemiology and Health Care, University College London, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the Canadian Partnership Against Cancer, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, and others. For full disclosures of the study authors, visit thelancet.com.
