Sunday 20 October 2019

3,000 patients a year told they have cancer in A&E

(stock photo)
(stock photo)
Eilish O'Regan

Eilish O'Regan

More than 3,000 cancer patients a year are only discovering they have the illness after attending A&E - and for many the disease is already advanced, a damning report reveals today.

One in seven of the 22,000 new invasive cancer cases here annually is being picked up after the patient presents to an often chaotically overcrowded hospital emergency department.

Older people, as well as patients from poorer backgrounds, are most likely to find out they have cancer in this way.

The worrying trend - in which six patients a day are given the devastating news - is laid bare in a report commissioned by the Irish Cancer Society and based on figures from the National Cancer Registry of Ireland.

Nearly eight in 10 of these patients are being told they have late-stage cancer, which reduces their chances of survival.

It warned of "stark inequalities" in cancer diagnosis, highlighting that "if you are older or from a deprived area" you are far more likely to be diagnosed as an emergency.

The odds are also increased that the tumour is advanced.

The report points out that the reasons patients are first told they have the disease in emergency departments are complex. They can include poor awareness of symptoms, failure to consult a GP or lack of timely access to scans.

Previous research showed half of Irish GPs have no direct access to diagnostic tests for "urgent" patients and, in some cases, there is limited availability of fast-track diagnostics for symptoms of pancreatic, brain, head and neck cancers.

The findings reveal:

Cancer patients from the least well-off areas are 50pc more likely to be diagnosed in A&E departments, compared to those from the most affluent communities;

Nearly three out of four emergency cases involve patients aged over 65 compared with just over half of patients who are diagnosed in the normal way;

Older patients are twice as likely to present as emergencies.

Cancers which are most likely to be detected in A&E include diseases of the pancreas, liver, brain and central nervous system, leukaemia, lung, ovary, colon and stomach.

However, it is also happening in a lower scale for common cancers including diseases of the breast, prostate, thyroid and cervix. Thyroid cancer is 10 times more likely to be found among the over-65s in an A&E.

The proportion of men and women is similar, although the risks were higher in males for Hodgkin lymphoma, non- Hodgkin lymphoma and melanoma.

The report found the proportion of cases diagnosed in A&E in 2002 was as high as 20pc, compared to 14pc in 2009. But there has been no improvement since then.

The Government's National Cancer Strategy 2017-2026 aims to reduce the proportion of cancers diagnosed in A&E by 50pc.

However, the report said that without concrete measures this target will not be realised.

It pointed out that while cancer survival rates overall in Ireland are higher than they have ever been, in some cancers - like pancreas and lung - rates are low.

The cancer gap in Ireland also shows you are twice as likely to die from cancer if you come from the poorest communities.

Professor Kerri Clough-Gorr, director of the National Cancer Registry of Ireland, said: "A diagnosis in an emergency department presents huge challenges for patients and means higher costs for the health system."

The report makes a range of recommendations including providing GPs with more direct access to diagnostic scans for patients.

The diagnostics also need to be developed more outside of hospital in primary and community settings.

It also highlights the need for targeted public awareness campaigns on the signs and symptoms of cancer.

A rapid pathway to treatment for patients diagnosed in a hospital emergency department is also essential.

Each patient should have a case review to learn more about how they came to be diagnosed there and more research should also be carried out to shine a light on the causes of emergency presentation.

Irish Independent

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