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Third of emergency cancer presenters never saw GP

Emergency cancer diagnosis doesn’t signal missed GP diagnosis, but more help still needed

Louise Prime

Tuesday, 25 April 2017

About a third of people whose cancer is diagnosed as an emergency in England had not once consulted their GP about a relevant problem, according to new research, which contradicts previous suggestions that emergency cancer presentations represent missed diagnosis by GPs. However, it also showed that nearly a quarter of patients had visited their GP three or more times before being diagnosed as an emergency. The Royal College of GPs said timely diagnosis of cancer is a priority for GPs, and called for better GP access to diagnostic tools to help them spot cancer earlier.

Patients diagnosed with cancer as an emergency generally have poorer outcomes, as their disease is usually at a later stage. For a Cancer Research UK-funded study* published today in the British Journal of General Practice, researchers from University College London, The University of Cambridge, The University of Exeter and Public Health England analysed data from the 2010 English Cancer Patient Experience Survey, covering 18 different types of cancer in 4,647 cancer patients, to find out how many times they had visited their GP before their disease was diagnosed as an emergency.

They reported that among these emergency presenters, 1,349 (29%) reported no previous primary care consultations with relevant symptoms. This was more common in males (32% versus 25% in females), older patients (44% in those aged ≥85 years versus 30% in 65-74-year-olds), and the most deprived patients (35% versus 25% least deprived). Cancer Research UK pointed out that a range of practical, emotional and health barriers can make these groups less likely to seek GP help promptly. Highest rates of emergency presentation were for patients with brain cancer (46%), and lowest rates for mesothelioma (13%).

But the research team also found that among 3,298 emergency presenters with prior consultations, 1,356 (41%) had three or more consultations, which were more likely in females, younger, and non-white patients and those with multiple myeloma, and least likely for patients with leukaemia.

They commented: “Contrary to suggestions that emergency presentations represent missed diagnoses, about one third of emergency presenters (particularly those in older and more deprived groups) have no prior GP consultations. Furthermore, only about one third report multiple (three or more) consultations, which are more likely in ‘harder-to-suspect’ groups.”

Dr Georgios Lyratzopoulos, one of the lead researchers based at UCL, said: “These findings tell us that some patients diagnosed as an emergency might not be acting on ‘red flag’ symptoms which could have prompted them to visit their GP. There’s also a host of other factors that may be at play. For example, many elderly patients may find it difficult to get to the surgery or have other conditions which would prevent them from seeking an appointment, such as dementia.

“This highlights the need to explore all the reasons why cancers are diagnosed late, including what happens outside GP surgeries. It also shows that late diagnosis is more complex than it’s often presented to be, as there are multiple reasons why cancers are spotted late.”

The RCGP said GPs take very seriously their role in diagnosing cancer as early as possible, and urged patients with any concerning or persistent symptoms to book an appointment with their GP.

RCGP chair, professor Helen Stokes-Lampard, commented: “There are still some patients who seem to be missing or ignoring worrying symptoms until they are severe enough to send them to A&E. They are not seeing their family doctor at all, and are instead being diagnosed at a later stage as an emergency, which is known to reduce the chances of a good outcome ...

“Family doctors would be helped by increased access to new and improved diagnostic tools to help them identify cancers that are more difficult to spot, and this is something that the RCGP has long been calling for.”

* Abel GA, Mendonca SC, McPhail S et al. Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data. Br J Gen Pract 24 April 2017. DOI: 10.3399/bjgp17X690869.

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