Diagnosis of cancer as an emergency: a critical review of current evidence
Nature Reviews Clinical Oncology
Nature Publishing Group
Reason for embargo
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.
Y. Z. acknowledges an Academic Clinical Fellowship in General Practice funded by Health Education East of England. F.M.W. acknowledges funding from a UK National Institute for Health Research Clinician Scientist award. G.L. acknowledges funding from Cancer Research UK (Advanced Clinican Scientist Fellowship Award, grant number A18180).
This is the author accepted manuscript, with the working title of "Defining, measuring and preventing the diagnosis of cancer as an emergency: a critical review of current evidence" . The final version is available from the publisher via the DOI in this record, and is entitled "Diagnosis of cancer as an emergency: a critical review of current evidence"
Vol. 14, pp. 45 - 56
Place of publication