3000 people a year told they have cancer in busy A&E departments - Report

Older people, as well as patients from less well-off backgrounds, are most likely to find out they have the disease in overcrowded hospital emergency departments.

Donal Buggy, Head of Services and Advocacy at the Irish Cancer Society said:

The number of patients being diagnosed with cancer in emergency departments is worrying. 14% of cancers diagnosed in Ireland between 2010 and 2015 were emergency presentations through hospitals, and the overwhelming majority of these were at a late stage.

“By the time a patient arrives in an emergency department they are probably not only presenting with acute symptoms, but wracked with worry and fearful about what happens next. Unfortunately, a late diagnosis often means fewer treatment options are available and a reduced chance of survival. Urgent steps need to be taken so people get diagnosed earlier.”

Speaking at the launch of the report, Mr. Buggy said: “In this report, the Irish Cancer Society is proposing the early implementation of a number of actions to tackle emergency presentation of cancer and, most importantly, save lives and improve outcomes for patients.”

These include:

• Direct access to diagnostics for GPs at secondary care level
• Reduced public waiting times for access to diagnostic tests for cancer
• The development of diagnostics in primary and community care settings
• Targeted public awareness campaigns on the signs and symptoms of cancer
• Development of a rapid access pathway to treatment for people diagnosed in an emergency
• A significant incident case review for cancer patients diagnosed as an emergency
• Further research to better understand the causes of emergency presentation

The research, funded by the Irish Cancer Society and carried out by the National Cancer Registry of Ireland, found that:

• Cancer patients from the most disadvantaged communities are 50% more likely to be diagnosed via emergency presentation than those from the most affluent communities.
• Nearly 3 out of 4 emergency cases involve patients over 65 compared with just over half of elective cases, and older patients are twice as likely to present as emergencies.
• Certain cancers, including pancreas (34%), liver (34%), brain/central nervous system (34%) leukaemia (27%), lung (26%), ovary (24%), colon (22%) and stomach (20%), had an especially high proportion of emergency presentations.

Mr. Buggy said it highlighted “stark inequalities” in cancer diagnosis. “Unfortunately, if you are older or from a deprived area, you are far more likely to be diagnosed as an emergency, and there is a strong chance that your cancer is already at a late stage.”

The National Cancer Strategy 2017 – 2026 aims to reduce the proportion of cancers diagnosed in Emergency Departments by 50% by 2026. If our actions are adopted, they will go some way to achieving this target and, ultimately, save lives.

“Our proposals are far-reaching and will inform a number of targets in the National Cancer Strategy, including a reduction in cancer inequalities. We’re calling on the National Cancer Control Programme and Department of Health to take up these actions which set clear targets that will support implementation of the National Strategy.”

Professor Kerri Clough-Gorr, Director of the NCRI and Professor of Cancer Epidemiology at University College Cork added: “We are delighted to undertake this vital research in conjunction with the Irish Cancer Society. This is the first time in Ireland we have this data, and we will continue to monitor these figures in our Annual Reports into the future.”

“Nobody wants a cancer patient diagnosed as an emergency. A diagnosis in an emergency department presents huge challenges for patients, and means higher costs for the health system. Thankfully, some progress has already been made and the proportion of cancers being diagnosed via emergency presentation fell sharply from 20% in 2005 to 14% in 2009, but there has been little change since then.”

- Digital Desk