One in three cases of cancer in patients over 70 are diagnosed at emergency admission

BMJ 2012; 345 doi: (Published 21 September 2012) Cite this as: BMJ 2012;345:e6402
  1. Zosia Kmietowicz
  1. 1London

Nearly one in four cases of cancer in England (24%)—around 58 400 a year—are diagnosed when patients are admitted to hospital as emergencies, a study has found. This figure rises with age to more than a third (31%) of cancers in people over 70: 38 500 cases.

The study by the National Cancer Intelligence Network traced the experiences of nearly three quarters of a million English patients who were given cancer diagnoses (739 667) between 2006 and 2008 to find out how their illness was diagnosed.1

It found that the proportion of cancer cases diagnosed after emergency admission varied widely by cancer type. Cancers of the brain and central nervous system were most likely to be picked up at an emergency admission, with 62% diagnosed this way. These were followed by cancer of the pancreas (half of these cases were diagnosed at emergency admission), and lung cancer (39%).

Cancers least likely to be diagnosed at emergency admission were those with signs and symptoms that could be easily identified, such as melanoma (just 3% of cases were diagnosed in emergency departments), breast cancer (5%), and cancer of the uterus (8%).

Relative survival at one year was lower for every type of cancer in patients whose cases were diagnosed as emergencies than those whose cancers were diagnosed by any other route. With bladder cancer, for example, one year relative survival was 36% after an emergency presentation but 83% after an urgent referral by the GP and 79% after a routine GP referral.

Sara Hiom, director of information at Cancer Research UK and one of the study authors, said that the findings were “startling,” although the reasons for the late presentations were not clear.

“Although we might expect higher numbers of older patients to have cancer detected as an emergency, we urgently need to understand why there is such a great proportion,” he said. “It may be that older people are reluctant to bother their doctor with possible cancer symptoms, or they could be slipping through the net as symptoms may be dismissed as ‘the usual aches and pains’ or ‘old age,’ or their GP could have referred them but their condition has progressed so rapidly that they end up as an emergency in hospital.”

Sarah Woolnough, executive director of policy at the charity Cancer Research UK, said that it was “truly shocking” and “deeply concerning” that people aged over 70 are twice as likely as younger people to receive a diagnosis through this route.

“At the moment, the difference in figures could suggest ageism in the NHS, which would be unacceptable.”

Jane Maher, chief medical officer at the charity Macmillan Cancer Support, said that the figures on cancer diagnoses among elderly people were “appalling” and that the effect on survival of such late detection could be “disastrous.”

She added, “It can be more difficult to spot cancer symptoms in older people who have other health conditions, but this does not excuse such a high number of people being diagnosed in this way.

“All cancer patients should be given the best possible survival chance, and we owe it to the older members of our society to ensure that this applies equally to them.”


Cite this as: BMJ 2012;345:e6402


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