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Fewer cancers diagnosed as emergencies, study finds

The number of patients diagnosed with cancer as an emergency has declined, according to a new study.

The research, published in the British Journal of General Practice, found that emergency referrals from GPs had declined by around a half between 2006 and 2015.

The authors said this trend suggests an increase in GPs using two-week wait referrals and earlier diagnosis in general practice overall.

The study looked at over half a million patients with cancer who presented as emergencies between 2006 to 2015.

Out of the patients who had to be referred for emergency treatment, the number of emergencies that presented to GPs halved between 2006 and 2015, from 31% to 17%. In comparison, emergencies presented to A&E increased from 55% to 68%.

The number of emergencies in total also decreased from 56,104 in 2006 to 54,142 in 2015.

The authors of the study said: ‘Around one in five patients with cancer are diagnosed as an emergency, which is associated with worse clinical and patient experience outcomes compared with other diagnostic routes; these poorer outcomes are partially explained by later stage at diagnosis and disease-related complications.

‘[The decrease] likely reflects a reciprocal rise in the use by GPs of two-week wait referrals for suspected cancer in the same period.’

They added: ‘Among emergency presenters, reductions in the GP emergency presentation sub-route could reflect increasing difficulties in accessing in-hours primary care among patients with possible cancer symptoms, and the progressive shrinkage (through the overall increase in two-week wait referrals) of the pool of patients who would have otherwise been diagnosed with cancer as an emergency presentation.’

Professor Georgios Lyratzopoulos, author of the study and professor at UCL, said: ‘More than a decade of monitoring trends in care pathways before the diagnosis of cancer reveals that the NHS is continually getting better in diagnosing cancer earlier and avoiding emergency presentations.

‘GPs have played a crucial role in these improvements.

‘But we also need new tests to help assess patients with non-specific symptoms, novel diagnostic technologies are still much needed today as they were a decade ago.’

Professor Martin Marshall, vice chair of the RCGP, said: ‘This drop in cancers being diagnosed as emergency presentations is a testament to the vigilance of GPs and our team members who understand the importance of timely diagnosis, and work hard to strike the balance between over, under and appropriate referral.

‘In cases where cancers are diagnosed as an emergency, it’s important to note that some types of cancer, such as pancreatic cancer, are notoriously difficult to spot in the early stages, either because symptoms might initially be vague and indicative of other, more common conditions – or because there may be no symptoms, at all.’

He added: ‘GPs are highly-trained to spot possible symptoms of the disease before recommending patients onto specialist referral. But the best way to further build on the positive progress we’re seeing with cancer diagnosis in this research, is to give GPs better access to the right diagnostic tools in the community – and the appropriate training to use them.’

It follows reports of record A&E attendances and worst-ever referral waiting times, according to official data.

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