title: Lung cancer patients in New Zealand initially present to secondary care through the emergency department rather than by referral to a respiratory specialist.
abstract: BACKGROUND
  The previous study established that lung cancer patients in Auckland-Northland most commonly presented to secondary care through the emergency department (ED).
  
  
  OBJECTIVE
  To further explore the characteristics and presentation of cases presenting through EDs in Auckland.
  
  
  METHODS
  Data were collected for all lung cancer cases (2004) in Auckland that initially presented to secondary care via ED RESULTS: Of (478) lung cancer cases diagnosed in Auckland in 2004, 170 cases (36%) presented via ED. ED presentation varied with tumour stage (p<0.0005), ethnicity (p=0.01), and DHB (p=0.004). Of the patients presenting to ED for whom records were available (159; 94%): 107 (67%) had respiratory symptoms; 66 (42%) were GP-referred; of these, 22 had had a CXR; 6 (4%) were already under respiratory surveillance; and 11 (6%) had previously been seen by secondary care regarding the presenting symptoms. All cases (except 1) were admitted. GP referral varied across DHBs (p=0.04) and ethnic groups (p=0.02). Age, gender, and tumour type were not associated with ED presentation.
  
  
  CONCLUSIONS
  Lung cancer patients, especially those of Pacific ethnicity, commonly presented as emergencies, often by-passing primary care. This suggests barriers to, or within, primary care and further research is required to explore the reasons underlying these findings.
authors.affiliation: Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
authors.forename: Sarah
authors.initials: S
authors.lastname: Beatty
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
authors.forename: Graham
authors.initials: G
authors.lastname: Stevens
authors.forename: John
authors.initials: J
authors.lastname: Kolbe
authors.forename: Brian
authors.initials: B
authors.lastname: Cox
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009520:New Zealand / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000379:methods*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012124:Respiratory Care Units / Q000706:statistics & numerical data*; D012189:Retrospective Studies