Lung cancer diagnosed following an emergency admission: Mixed methods study of the management, outcomes and needs and experiences of patients and carers.
In the UK, although 40% of patients with lung cancer are diagnosed following an emergency admission (EA), data is limited on their needs and experiences as they progress through diagnostic and treatment pathways.



Prospective data collection using medical records, questionnaires and in-depth interviews. Multivariate logistic regression explored associations between diagnosis following EA and aspects of interest. Questionnaire responses with 95% confidence intervals were compared with local and national datasets. A grounded theory approach identified patient and carer themes.



Of 401 patients, 154 (38%) were diagnosed following EA; 37 patients and six carers completed questionnaires and 13 patients and 10 carers were interviewed. Compared to those diagnosed electively, EA patients adjusted results found no difference in treatment recommendation, treatment intent or place of death. Time to diagnosis, review, or treatment was 7-14 days quicker but fewer EA patients had a lung cancer nurse present at diagnosis (37% vs. 62%). Palliative care needs were high (median [IQR] 21 [13-25] distressing or bothersome symptoms/issues) and various information and support needs unmet. Interviews highlighted in particular, perceived delays in obtaining investigations/specialist referral and factors influencing success or failure of the cough campaign.



Presentation as an EA does not appear to confer any inherent disadvantage regarding progress through lung cancer diagnostic and treatment pathways. However, given the frequent combination of advanced disease, poor performance status and prognosis, together with the high level of need and reported short-fall in care, we suggest that a specialist palliative care assessment is routinely offered.
Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.
Andrew
A
Wilcock
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Vincent
V
Crosby
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Asmah
A
Hussain
Division of Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK.
Tricia M
TM
McKeever
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Cathann
C
Manderson
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Sarah
S
Farnan
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Sarah
S
Freer
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Alison
A
Freemantle
Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Fran
F
Littlewood
Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, UK. Electronic address: glenys.caswell@nottingham.ac.uk.
Glenys
G
Caswell
Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, UK.
Jane
J
Seymour
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D019468:Disease Management; D018450:Disease Progression; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010166:Palliative Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
Lung cancer; Non-small cell lung cancer; Palliative care; Small cell lung cancer