Cancer diagnosis in accident and emergency departments are three times more likely in some parts of England than others, HSJ analysis reveals.
Public Health England data shared with HSJ shows the number of cancer diagnoses in emergency care, often when a patient has attended for another reason, vary from 11 per cent of all cancer diagnoses in one clinical commissioning area to 33 per cent in another.
The figures indicate which areas are better at detecting cancers at an early stage and in primary care services. The percentage of cancer cases diagnosed during an emergency visit to hospital is recognised as a proxy for the effectiveness of primary care.
The national average according to the most recent available data, for quarter three of 2015-16, is 20 per cent of cancer cases being diagnosed in A&E.
In the same period, South Manchester CCG had the highest rate of 33 per cent, compared to 11 per cent for North Somerset CCG, which was the lowest.
The 10 CCGs with the most diagnosis in A&E in quarter three of 2015-16 were:
- South Manchester – 33 per cent
- Kingston – 31.5 per cent
- Stoke on Trent – 28 per cent
- Barking and Dagenham – 27.6 per cent
- Basildon and Brentwood – 27.4 per cent
- Newham – 27 per cent
- North Kirklees – 27 per cent
- Darlington – 26.2 per cent
- Sandwell and West Birmingham – 25.7 per cent
- Blackburn with Darwen – 25.6 per cent
Kingston’s and North Kirklees’ results were outside their normal range across previous quarters as the data for one of the months in quarter three was not included in the PHE data. (See attached spreadsheet)
The other eight CCGs had consistently above average rates, going back to quarter two of 2012-13.
Colorectal, lung and bowel cancer were identified by CCGs as drivers of the high rate of emergency department diagnosis.
South Manchester CCG chief officer Caroline Kurzeja said: “We have been working with the national Accelerate, Coordinate, Evaluate programme to pilot ways of increasing uptake of bowel screening and through the Manchester Cancer Investment Programme have developed innovative work to detect lung cancer and colorectal cancer earlier, two cancers with the highest rate of emergency presentation.
“A clinic in University Hospital South Manchester to detect and refer patients with non-specific but concerning symptoms has been set up and this work sits alongside all the work taking place in primary care to educate GPs on early diagnosis as well as improving the numbers of patients taking up screening.”
Darlington CCG said it was working with Macmillan Cancer Support to “develop a comprehensive local picture of cancer and its associated outcomes to gain a better understanding of areas for improvement.
“As a result of this work, the high number of emergency presentations for cancer has been identified, in addition to poor one year survival rates for cancers overall. Lung cancer and colorectal cancer have been noted as being of particular relevance in Darlington, with poor recorded patient outcomes for both”.
“In response to these findings, and in order to understand why people are not being diagnosed earlier, two specific pieces of work are being developed for 2017. The CCG, working with local health professionals, Macmillan Cancer Support and Cancer Research UK, is now focusing on two specific areas of Darlington with the highest reported incidence of lung and colorectal cancers. The aim is to evaluate prevention and early diagnosis activity in these areas and to identify and trial improvements to patient engagement.”
Newham CCG is also working with Macmillan to try to help GPs diagnose cancer earlier. The east London group said it had seen an improvement since quarter three of 2015-16.
A spokeswoman for Barking and Dagenham CCG said: “While Barking and Dagenham’s cancer survival rates have improved year on year over the past decade. This is not happening as quickly as in other boroughs, so improving this picture is a priority.”
Pelham Allen, chair of the University College London Hospitals Foundation Trust Cancer Collaborative, said the problem was one all English cancer alliances were focused on.
He said: “If a large proportion of the population are not registered with a GP – perhaps because of a transient population, language or cultural issues, or shortage of GPs – and/or it is difficult to get a GP appointment, more cancer cases will not be diagnosed until the patient has symptoms requiring emergency treatment.
“In any event, the number of cancer patients diagnosed following an emergency visit to hospital is much too high. Early diagnosis is key to improving cancer outcomes, and the principal focus of the UCLH Cancer Collaborative and of the other cancer alliances across the country.”
- Acute care
- Emergency care
- NHS Barking and Dagenham CCG
- NHS Basildon and Brentwood CCG
- NHS Blackburn with Darwen CCG
- NHS Darlington CCG
- NHS Kingston CCG
- NHS Newham CCG
- NHS North Kirklees CCG
- NHS North Somerset CCG
- NHS Sandwell and West Birmingham CCG
- NHS South Manchester CCG
- NHS Stoke on Trent CCG
- Patient experience
- Primary care
- Public Health England
- Quality and performance