What explains diagnosis of lung or bowel cancer as an emergency?
In England, 39% patients with lung cancer and 26% patients with bowel cancer are diagnosed as an emergency in secondary care and these patients have poor survival. We aimed to describe these patients to identify opportunities to improve survival by promoting earlier diagnosis.
We developed a new measure, the Patient Account Interview, which is a schedule asking about nature and duration of symptoms and GP attendances. We collected data from a series of patients diagnosed with lung or bowel cancer after emergency presentation to one of seven trusts in South and West London over one year. We are also collecting data from patients' GPs and secondary care.
By end May 2014, the trusts identified 329 eligible patients; 162 patients (121 lung cancer, 41 bowel cancer) had consented to take part. In a preliminary analysis of 37 patients interviewed in 2013, most patients had stage III+ disease. About half had a short history of symptoms (<12 weeks). Among those with longer duration of symptoms, about 20% had delayed presentation and about 20% had evidence of delay in primary care. Early results suggest that patients who delayed going to the doctor were older and more likely to report fear of what the doctor might find. Patients who experienced delay in primary care tended to be female and younger and had attended primary care several times.
Analyses for the whole patient group are under way and will be reported at the conference. Expected outputs include: demographics and nature and duration of symptoms; clinical patterns and characteristics of the three distinct groups of patients (those with short duration of symptoms, those with patient delay and those with delay in primary care). The data will inform interventions to promote prompt diagnosis in these patients.
We would like to gratefully acknowledge Theo Giannopoulos and Susanne Booth at Castle Hill Hospital for their help in acquiring ovarian tissue samples, and Jane Smales for coordinating the clinical aspects of the study. This study is funded by a grant from NC3Rs (Registry File: G1100600).
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