title: Diagnosis of cancer as an emergency: a critical review of current evidence.
abstract: Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.
authors.affiliation: The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK.
authors.forename: Yin
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK.|University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Abel
authors.affiliation: University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK.
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.|University College London Partners Academic Health Science Network, 170 Tottenham Court Road, London W1T 7HA, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Pritchard-Jones
authors.affiliation: Section of General Medicine, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Cristina
authors.initials: C
authors.lastname: Renzi
authors.affiliation: National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Johnson
authors.affiliation: National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: McPhail
authors.affiliation: National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Elliss-Brookes
authors.affiliation: The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK.|Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.|National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D055088:Early Detection of Cancer; D004630:Emergencies; D004638:Emergency Treatment / Q000706:statistics & numerical data; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017567:Karnofsky Performance Status; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult