Diagnosis of cancer as an emergency: a critical review of current evidence

Abstract

Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.

Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data

“…While the present findings indicate that two-thirds of emergency presenters had at least one prior primary care consultation, previous analysis indicates that GPs are directly involved (that is, through direct emergency referral to hospital services) in one-third of all emergency presentations 11. Assuming that emergency presenters who were referred to hospital as emergencies by their GP would consider such involvement to be a prior consultation, the combined interpretation of these figures would indicate that at least one-third of all emergency presenters have had prior contact with GPs but were not referred as emergencies.…”

“…As emergency presentations are associated with poorer survival and worse patient experience, reducing their frequency is desirable, but how to achieve such reductions is uncertain 5 – 8. Complex aetiologies, reflecting different disease (tumour), patient, and healthcare factors, often in combination, are likely to be implicated 9 – 11. Prior evidence indicates that older patients and patients who are more socioeconomically deprived are at substantially higher risk of diagnosis of cancer as an emergency 1 , 3 , 4.…”

“…Prior evidence indicates that older patients and patients who are more socioeconomically deprived are at substantially higher risk of diagnosis of cancer as an emergency 1 , 3 , 4. An ecological study indicates a degree of variation by certain general practice characteristics, but overall there is very limited evidence about whether and how diagnoses of cancer through an emergency presentation can be avoided 11 , 12…”

“…As also highlighted by the findings of a recent in-depth review of the diagnosis of cancer as an emergency, evidence on the proportion of emergency presenters with and without previous consultations is very limited 11. This study aimed to examine variation (by patient characteristic and cancer site) in the presence and number of prior consultations with a GP among emergency presenters, to provide insights into aetiological mechanisms responsible for such presentations.…”

Early Diagnosis with 11-Gene Panel Screening for Non Small Cell Lung Cancer

“…Therefore, one of the major challenges for lung cancer lies in early precision diagnosis. Currently, routine clinical diagnostic methods includes tumor markers detection, computed tomography screening, histopathological detection and so on which are basically from the point of serology, imaging and pathology [9] and the optimal means of diagnosis are uncertain and lack of data of precision medicine owing to the involvement of different tumors, patient and health-care factors, often in combination [10]. Numerous genetic alterations associated with lung cancer have been identified that might contribute to the development of specific types of lung cancer, patterns of metastasis, drug resistance, or disease recurrence [11].…”