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1 in 4 cancer patients in Northern Ireland diagnosed through emergency routes

Over a quarter of cancers in Northern Ireland (27.9%) are being diagnosed through emergency routes like hospital A&E departments.

This is according to new analysis by the International Cancer Benchmarking Partnership (ICBP), which is hosted by Cancer Research.

More cancers are being diagnosed when patients come to the attention of emergency hospital medics in Northern Ireland than in some comparable high-income countries.

The study, published in The Lancet Oncology, was supported by NI Cancer Registry at Queen's University Belfast. It looked at 857,068 cancer cases diagnosed between 2012 and 2017, in six comparable countries (Australia, Canada, Denmark, New Zealand, Norway and the UK). Cancer types included were oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancers.

 In the first study of its kind, researchers at University College London found that over a third of patients in England (37%), Wales (37.4%) and Scotland (38.5%) were diagnosed after being rushed into hospital. In Northern Ireland, which was measured using a different definition, emergency presentations accounted for over a quarter (27.9%) of diagnoses.

This is the first time we have seen figures for the UK nations alongside data from comparable countries and the charity is now calling for government to act on this worrying picture.  Northern Ireland lagged behind Victoria in Australia but fared better than Denmark.

Margaret Carr, Cancer Research UK’s public affairs manager in Northern Ireland, said: “This is a worrying study as it confirms that too many people are only being diagnosed with cancer once their health has deteriorated to a point when they might need to go to A&E or rushed into hospital. 

“This is concerning because cancer survival is lower among patients whose cancer is diagnosed after being admitted to hospital as an emergency.

“If we want to build a world-class cancer service in Northern Ireland, we need to ensure fewer patients are being diagnosed with cancer in this way.” 

She added: “Despite the best efforts of its workforce, healthcare services are creaking under the weight of the pandemic, staff shortages and an overall lack of investment.

“We know that one reason so many people end up in A&E is because we don’t have enough staff and kit to test and diagnose cancer through usual routes.

“This is why we need to see long term funding for the recently announced ten-year cancer strategy for Northern Ireland. Without this there’s a real risk that cancer survival could go backwards.”

 The proportion of emergency presentations ranged from 42.5% in New Zealand to 24% in the Australian state of Victoria – indicating a global problem.

Older patients and those with advanced cancer were most likely to be diagnosed through an emergency route – as were cancers with often non-specific, vague symptoms, such as pancreatic, liver, lung, and ovarian.

The study also found that countries with higher levels of emergency presentations had poorer cancer survival. For every 10% increase in emergency presentations in the studied countries, there was a decrease in one-year survival for six of the eight cancer types – ranging from 2.5% for ovarian cancer to 7% for colon cancer.  

And experts are worried that COVID-19 has exacerbated the situation. Fewer people coming forward with symptoms and reduced access to cancer tests mean the number of emergency presentations are expected to have increased.

The researchers highlight the need for better symptom awareness, reduced barriers to cancer screening – particularly for bowel cancer – and additional diagnostic capacity to improve the early diagnosis of cancer. They also encouraged better monitoring of emergency presentations across participating countries.

Dr Anna Gavin from the NI Cancer Registry at Queen's University Belfast and co-author on the paper said: "Being a part of international research like this is vital for understanding how Northern Ireland stacks up against other comparable countries, but it also crucially, helps to identify where we can learn from others.  As a result of this project, the NI Cancer registry now reports emergency presentation as a variable in the official cancer statistics. These figures highlight the need for better awareness of the symptoms of cancer to promote earlier diagnosis."

Professor Georgios Lyratzopoulos, lead researcher from University College London, said: “This is the first population-based study to ever look at diagnoses of cancer through emergency presentations internationally and to examine their link to survival. It has given us valuable insights into which patients and cancers are more likely to be diagnosed after an emergency hospital admission. Vulnerable patients – those who are older or with advanced disease – are disproportionately affected around the world.

“The data tell us that emergency presentations are a global problem – and not concentrated in a single country or health system. Getting better at preventing cancer, detecting it through screening, or diagnosing it soon after symptoms appear can help decrease emergency presentations and reduce cancer deaths. This message applies to Canada, Europe and Oceania, as well as the UK.”

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