Quarter of bowel cancers only discovered from emergency hospital
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
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
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
- 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
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.”