Determinants and time trends (2006-2015) of cancer diagnosis after emergency GP referral or A&E attendance in England

Annie Herbert, Gary A Abel, Sam Winters, Sean McPhail, Lucy Elliss-Brookes, Georgios Lyratzopoulos

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BackgroundDiagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to appreciate the critical and evolving role of general practice in diagnostic pathways for cancer patients.
AimTo examine socio-demographic, cancer site, and temporal associations with type of presentation among cancer patients diagnosed as emergencies.
Design and settingAnalysis of Routes to Diagnosis data 2006-2015 for patients with cancer in England.
MethodWe estimated adjusted proportions of emergency presentation after emergency GP referral (GP-EP) or presentation to Accident & Emergency (AE-EP), by patient characteristic, cancer site, and year of diagnosis, using multivariable regression.
ResultsAmong 554,621 emergency presenters, 24% presented as GP-EP and 62% as AE-EP (14% through Other-EP sub-routes). Emergency presenters were more likely to have been GP-referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder or ovarian cancer, or acute leukaemia. During the study period the proportion and number of GP-EPs nearly halved (31%/17,364 in 2006; 17%/9,155 in 2015) whilst that of AE-EP increased (55%/31,049 to 68%/36,868).
ConclusionEmergency presenters with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (e.g. pancreatic cancer manifesting as painless jaundice) are over-represented among cases involving GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of two-week-wait GP referrals during the study period and reductions in emergency GP referrals.
Original languageEnglish
Pages (from-to)e724-e730
Number of pages7
JournalBritish Journal of General Practice
Issue number687
Early online date26 Sept 2019
Publication statusPublished - Oct 2019


  • early diagnosis
  • emergencies
  • patients
  • population groups
  • referral and consultation


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