Quarter of bowel cancers only discovered from emergency hospital admission

31 October 2012

About a quarter of bowel cancer patients in England are only diagnosed with the disease after an emergency admission to hospital, new advanced research from a national audit has found.

This equates to about 8,000 out of 31,000 patients admitted in a 12 month period, whose records were analysed by the National Bowel Cancer Audit and linked for the first time with hospital data (Hospital Episode Statistics).

These patients are less likely to have surgery than those whose first admission was not an emergency case according to today’s supplementary report, which was commissioned by the Healthcare Quality Improvement Partnership and developed by the Association of Coloproctology of Great Britain and Ireland, the Royal College of Surgeons of England and the Health and Social Care Information Centre.

Today’s finding about diagnosis upon emergency admission is in keeping with research by the National Cancer Intelligence Network about bowel cancer, which is diagnosed in about 31,000 people each year in England and Wales and is the second most common cause of cancer death.

The report suggests that between August 2009 and July 2010, diagnosis upon emergency admission was most common among:

  • Older people aged 85 and over: accounting for 47 per cent (1,690) of 3,580 patients of this age (the lowest prevalence was among those under 75, at 19 per cent (3,450) of 18,070 patients).
  • More deprived patients (based on the multiple index of deprivation: on a scale from 1 — the most deprived, to 5 — the least deprived). The percentage gradually increased from 22 per cent (1,410) of the 6,550 least deprived to 30 per cent (1,470) of the 4,940 most deprived.
  • Women: at 28 per cent (3,820) of 13,570 patients (for men, this figure was 22 per cent (3,870) of 17,240 patients).

The report also shows that, for emergency admission patients; 59% (4,540) had surgical intervention and 52% (3,990) had major surgery. This is lower than for non-emergency patients who present through other means (such as direct referrals or two-week wait), for whom the percentages were 76% (17,510) and 73% (16,850) respectively. This is likely to reflect the fact that emergency patients tend to have a more advanced stage of cancer on admission, as suggested by other findings in the audit.

Considering all 31,000 patient records included in the study; of the 20,000 patients who had major surgery:

Nearly one in five patients (about 3,700 out of 19,000) were readmitted to hospital as an emergency case within 90 days of having major surgery. Fewer than one in 10 patients (just under nine per cent, or about 1,800 out of 20,000) were taken back into theatre within 28 days of having major surgery.

The audit also considered data specifically on rectal cancer (a form of bowel cancer); based on about 7,300 patient records collected from a two-year period (2008 to 2010). It found that about four in five patients (83%, or 6,070) had a stoma (a surgical opening to the outside of the body) at the time of surgery, and, for whatever reason, nearly three in five (57%, or 4,180) still had a stoma 12 months on from surgery.

Possible regional variation was observed across most measures included in the report, but further data is needed to explore these potential differences.

Professor Paul Finan, clinical lead for the audit said, “The National Bowel Cancer Audit has, over the years, proved invaluable for all those charged with managing patients with bowel cancer. This additional work, combining voluntarily submitted audit data with routinely collected HES returns, offers a more complete picture of management across England. Lessons can be learnt from observed differences and are likely to lead to improvements in the diagnosis and treatment of patients.

“This new work adds to the data currently available on patients with bowel cancer and is likely to be used by trusts when examining their outcomes; eventually against quality measures currently under development by the National Institute for Health and Clinical Excellence; and also alongside published service profiles undergoing revision by the National Cancer Intelligence Network.”



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