A158: Survival of cancer presenting through A&E affected by age, cancer and treatment intent. Findings from the London Cancer A&E Audit

Neil Chauhan1,3,Melanie Ridge1,Michael Parker2,Kathy Pritchard-Jones1

1London Cancer, UCLPartners, London, UK,2Anglia Ruskin University, Cambridge, UK,3Barts Health, London, UK

Presenting date: Monday 2 November
Presenting time: 13.10-14.00

Background

A quarter of cancer diagnosis come through A&E. These patients often have advanced disease, and acute ill-health impacting physical status so fare worse than those on ‘managed' pathways. Accordingly, England's 1 year cancer survival is lower than the European average. National variation exists: north east London sees more cancer through A&E and worse 1 year survival than the England average.
London Cancer, the integrated cancer system for north east and central London and west Essex works to improve cancer care.

Method

London Cancer audited 9 acute trusts (Jan-Aug 2013). All cancers diagnosed following presentation via 12 A&E departments were centrally collated. Trusts provided patient level data. One year on, a look-back was performed to document survival.

Results

963 patients were diagnosed. 60 patients (6%) had no status returned. Median survival was under 6 months. 36% of patients survived 1 year from diagnosis.
Under 65 year olds had a median survival of 14 months and 50% one year survival. For 65 - 75 year olds: 5 months and 25% respectively. For those over 75 years: 3 months and 25% respectively.
Lung, colorectal and hepatopancreatobiliary (HPB) were the most common cancers. Median survival was 4, 18 and 3 months respectively. One year survival was 20%, 60% and 15% respectively. For an aggregate ‘other' group median survival was 10 months and one year 45%.
Palliative intent led to median survival less than 3 months and one year survival of 20%. For curative intent, the median has not been reached and one year survival was over 70%.

Conclusion

Cancer diagnosed through A&E has poor prognosis. A quarter died in 2 months and only 36% survived a year. Older patients and those fit for only palliative treatment have worse survival. Colorectal cancer patients survived longer reflecting surgery that is unavailable for advanced lung or HPB cancers. Early presentation to access managed pathways is key.