title: Clinical characteristics and outcomes for patients with an initial emergency presentation of malignancy: a 15 month audit of patient level data.
abstract: OBJECTIVE
  To investigate the demographics, diagnoses and outcomes for new adult cancer patients with an initial presentation via the A&E or acute oncology teams.
  
  
  BACKGROUND
  Patients with initial emergency presentation of malignancy have been documented to have poorer treatment outcomes and shorter survival. Patient level data on this subject is relatively limited with regard to the demographics, diagnoses and the clinical factors that may underlie late presentations.
  
  
  METHODS
  A 15 month audit of the patients presenting with a new diagnosis of malignancy was performed in 2011-2012. Data on demographics, diagnosis and outcome were assembled and analysed. The clinical data on emergency presentations were compared to reference information on the incidence and median age at presentation for each malignancy within the standard population.
  
  
  RESULTS
  During the study a total of 178 new cancer patients presented via the A and E service. The most frequent diagnoses were lung cancer with 21% of cases and CNS and colorectal cancer each with 9% of cases. There was a higher incidence of emergency new presentations of lung cancer, CNS tumours, ovarian, pancreatic and testicular cancer than in the standard population, whilst breast cancer, bladder cancer and prostate cancer patients were under-represented. The median age at diagnosis was 74 and for a number of malignancies including CNS tumours, breast cancer, colorectal cancer and head and neck cancer the emergency cases presented at significantly greater ages than in the standard population. Overall 27% of patients were unfit or unsuitable for a diagnostic biopsy, this group had only a 3 month median survival compared to 14 months for those suitable for biopsy and treatment.
  
  
  CONCLUSIONS
  Despite a wide range of initiatives, the emergency and late diagnosis of patients with metastatic cancer remains a significant challenge with many patients too advanced and unwell at presentation for active treatment. These patients tend to be older and have malignancies that present with either non-specific symptoms or symptoms requiring acute assessment. Improving the pathways for these patients will be challenging and require additional planning on improving awareness and access for these potentially hard to reach patients.
authors.affiliation: Department of Oncology, Charing Cross Hospital, London W6 8RF, UK. Electronic address: savage13561@msn.com.
authors.forename: Philip
authors.initials: P
authors.lastname: Savage
authors.affiliation: Department of Oncology, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Sharkey
authors.affiliation: Department of Oncology, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Teresa
authors.initials: T
authors.lastname: Kua
authors.affiliation: Department of Oncology, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Papanastasopoulos
authors.affiliation: Department of Oncology, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: McDonald-Burrows
authors.affiliation: Department of Oncology, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Shazalia
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Department of Emergency Medicine, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Fay
authors.initials: F
authors.lastname: Probst
authors.affiliation: Department of Emergency Medicine, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Sanders
authors.affiliation: Department of Emergency Medicine, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Millington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute oncology service; Audit; Emergency presentation; New cancer diagnosis