title: Impact of route to diagnosis on treatment intent and 1-year survival in patients diagnosed with oesophagogastric cancer in England: a prospective cohort study.
abstract: OBJECTIVE
  To investigate the relationship between the route to diagnosis, patient characteristics, treatment intent and 1 -year survival among patients with oesophagogastric (O-G) cancer.
  
  
  METHODS
  Cohort study in 142 English NHS trusts and 30 cancer networks.
  
  
  METHODS
  Patients diagnosed with O-G cancer between October 2007 and June 2009.
  
  
  METHODS
  Prospective cohort study. Route to diagnosis defined as general practitioner (GP) referral-urgent (suspected cancer) or non-urgent, hospital consultant referral, or after an emergency admission. Logistic regression was used to estimate associations and adjust for differences in casemix.
  
  
  METHODS
  Proportion of patients diagnosed by route of diagnosis; proportion of patients selected for curative treatment; 1-year survival.
  
  
  RESULTS
  Among 14 102 cancer patients, 66.3% were diagnosed after a GP referral, 16.4% after an emergency admission and 17.4% after a hospital consultant referral. Of the 9351 GP referrals, 68.8% were urgent. Compared to urgent GP referrals, a markedly lower proportion of patients diagnosed after emergency admission had a curative treatment plan (36% vs 16%; adjusted OR=0.62, 95% CI 0.52 to 0.74) and a lower proportion survived 1 year (43% vs 27%; OR 0.78; 95% CI 0.68 to 0.89). Urgency of GP referral did not affect treatment intent or survival. Routes to diagnosis varied across cancer networks, with the adjusted proportion of patients diagnosed after emergency admission ranging from 8.7 to 32.3%.
  
  
  CONCLUSIONS
  Outcomes for cancer patients are worse if diagnosed after emergency admission. Primary care and hospital services should work together to reduce rates of diagnosis after emergency admission and the variation across cancer networks.
authors: Clinical Effectiveness Unit,  The Royal College of Surgeons of England, London,  UK.
authors: Thomas R
authors: TR
authors: Palser
authors: David A
authors: DA
authors: Cromwell
authors: Richard H
authors: RH
authors: Hardwick
authors: Stuart A
authors: SA
authors: Riley
authors: Kimberley
authors: K
authors: Greenaway
authors: Jan H P
authors: JH
authors: van der Meulen