Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data
Patients who are diagnosed with cancer through an emergency presentation have poorer short-term survival compared to patients diagnosed through other routes. Many patients diagnosed through ED have had a visit with their GP within the weeks or months before diagnosis. This paper from the British Journal of Cancer explored the role of primary care in emergency cancer presentation in breast, colorectal, lung, melanoma, prostate and upper gastro-intestinal diagnoses of patients in Scotland. This article is the first to explore this method of diagnosis using a linked primary and secondary care data set. The authors reviewed cases notes for over 2100 patients, 360 of which were diagnosed with cancer through an emergency presentation. They found that 72% of patients did present to their GP in the lead up to their emergency presentation and that of these 50 patients had a primary care diagnostic pathway that was not within published standards. Additionally, 30% of patients were awaiting a secondary care intervention when their emergency presentation occurred. Overall the authors suggest that though GPs can be to blame for a missed cancer it is not as often as supposed. Patient delay and slow referral pathways may also contribute. Read the full article here.