UCLH A&ETo understand why a large number of people were being diagnosed with cancer via A&E departments, London Cancer conducted an audit of the 12 A&E hospital departments run by our partner acute trusts in 2013.

Diagnosis following an emergency presentation at A&E affects health outcomes for patients. Patients are more likely to die within a year, and even within three months if they are diagnosed following an emergency presentation. Nationally, the National Cancer Intelligence Network (NCIN) reported that 23% of cancers are diagnosed following emergency presentation

The results

The audit identified 963 patients that had a diagnosis of cancer following an emergency presentation at A&E.

  • The most common types of cancers identified were lung (32%), colorectal (18%) and upper gastrointestinal hepato-pancreatic-biliary (HPB) (12%) and haematology (8%)
  • Prognosis was poor for patients diagnosed via emergency presentation
  • 25% of patients died within two months, with only 36% surviving one year (lung, 20%; colorectal, 60%; HPB, 15%)
  • Older patients and those unfit for active treatment had worse survival
  • 50% of patients were under 65, 25% were aged 65-75 and 25% were over 75.

What next?

This project has prompted improvement work focussing on:

  • Enhancing GPs’ rapid access to diagnostics
  • Streamlining care for patients with non-specific but concerning symptoms, where there is no effective and direct pathway, via multidisciplinary diagnostic centre
  • Improving coordination of care ensuring that systems are in place to record diagnosis and effect timely return of this information to the GP.

We are also focusing on sharing examples of good practice across the region for the benefit of our entire population.