The effect of emergency presentation on surgery and survival in lung cancer patients in England, 2006-2008

Daniela Tataru; Ruth H. Jack; Michael J. Lind; Henrik Møller; Margreet Luchtenborg

doi:10.1016/j.canep.2015.04.008

The effect of emergency presentation on surgery and survival in lung cancer patients in England, 2006-2008

Daniela Tataru^*, Ruth H. Jack, Michael J. Lind, Henrik Møller, Margreet Luchtenborg

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

A large proportion of lung cancer patients in England are diagnosed through an emergency route, which is associated with poorer outcomes. Here, we investigated the association between emergency presentation and the odds of undergoing surgical resection and subsequent survival among lung cancer patients undergoing surgical resection as well as those who did not. Methods: Details of 93,783 lung cancers were extracted from the National Cancer Data Repository. For non-small cell lung cancer (NSCLC) patients we calculated odds ratios for undergoing surgical resection. Survival was assessed for resected NSCLC and for all other lung cancer patients in three different time intervals: short-term, intermediate and long-term. Results: Compared with those who did not, NSCLC patients presenting through an emergency route were less likely to undergo surgical resection (adjusted OR=0.22, 95% CI: 0.20-0.24). Patients who underwent surgical resection after an emergency presentation had lower survival in the intermediate period (adjusted HR=1.27, 95% CI: 1.06-1.54) and long term (adjusted HR=1.20, 95% CI: 0.99-1.45). Among all other lung cancer patients, those diagnosed through an emergency route had lower survival, particularly in the short-term (adjusted HR=3.54, 95% CI: 3.42-3.67), but the association remained in the intermediate (adjusted HR=1.66, 95% CI: 1.63-1.69) and long term (adjusted HR=1.10, 95% CI: 1.05-1.15). Conclusion: The reduced access to surgical resection and lower survival among lung cancer patients who present through an emergency admission, highlights the importance of ensuring symptoms are recognised early so that presentation as an emergency can be reduced.

Original language	English
Pages (from-to)	612-616
Number of pages	5
Journal	Cancer Epidemiology
Volume	39
Issue number	4
DOIs	https://doi.org/10.1016/j.canep.2015.04.008
Publication status	Published - 1 Aug 2015

Bibliographical note

Funding Information:
This paper is a contribution from the National Cancer Intelligence Network and is based on the information collected and quality assured by the National Cancer Registration Service in England ( www.ncin.org.uk/ ; http://www.ncr.nhs.uk/). The work was carried out by the former Thames Cancer Registry in King's College London which received funding from the Department of Health. The views expressed in the publication are those of the author(s) and not necessarily those of the Department of Health. The study was completed with the support of the London Knowledge and Intelligence Team, Public Health England.

Publisher Copyright:
© 2015.

Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.

Keywords

Emergency presentation
England
Lung cancer
Routes to diagnosis
Surgical resection
Survival

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.canep.2015.04.008

Cite this

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title = "The effect of emergency presentation on surgery and survival in lung cancer patients in England, 2006-2008",

abstract = "A large proportion of lung cancer patients in England are diagnosed through an emergency route, which is associated with poorer outcomes. Here, we investigated the association between emergency presentation and the odds of undergoing surgical resection and subsequent survival among lung cancer patients undergoing surgical resection as well as those who did not. Methods: Details of 93,783 lung cancers were extracted from the National Cancer Data Repository. For non-small cell lung cancer (NSCLC) patients we calculated odds ratios for undergoing surgical resection. Survival was assessed for resected NSCLC and for all other lung cancer patients in three different time intervals: short-term, intermediate and long-term. Results: Compared with those who did not, NSCLC patients presenting through an emergency route were less likely to undergo surgical resection (adjusted OR=0.22, 95% CI: 0.20-0.24). Patients who underwent surgical resection after an emergency presentation had lower survival in the intermediate period (adjusted HR=1.27, 95% CI: 1.06-1.54) and long term (adjusted HR=1.20, 95% CI: 0.99-1.45). Among all other lung cancer patients, those diagnosed through an emergency route had lower survival, particularly in the short-term (adjusted HR=3.54, 95% CI: 3.42-3.67), but the association remained in the intermediate (adjusted HR=1.66, 95% CI: 1.63-1.69) and long term (adjusted HR=1.10, 95% CI: 1.05-1.15). Conclusion: The reduced access to surgical resection and lower survival among lung cancer patients who present through an emergency admission, highlights the importance of ensuring symptoms are recognised early so that presentation as an emergency can be reduced.",

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author = "Daniela Tataru and Jack, {Ruth H.} and Lind, {Michael J.} and Henrik M{\o}ller and Margreet Luchtenborg",

note = "Funding Information: This paper is a contribution from the National Cancer Intelligence Network and is based on the information collected and quality assured by the National Cancer Registration Service in England ( www.ncin.org.uk/ ; http://www.ncr.nhs.uk/). The work was carried out by the former Thames Cancer Registry in King's College London which received funding from the Department of Health. The views expressed in the publication are those of the author(s) and not necessarily those of the Department of Health. The study was completed with the support of the London Knowledge and Intelligence Team, Public Health England. Publisher Copyright: {\textcopyright} 2015. Copyright: Copyright 2016 Elsevier B.V., All rights reserved.",

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AU - Lind, Michael J.

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AU - Luchtenborg, Margreet

N1 - Funding Information: This paper is a contribution from the National Cancer Intelligence Network and is based on the information collected and quality assured by the National Cancer Registration Service in England ( www.ncin.org.uk/ ; http://www.ncr.nhs.uk/). The work was carried out by the former Thames Cancer Registry in King's College London which received funding from the Department of Health. The views expressed in the publication are those of the author(s) and not necessarily those of the Department of Health. The study was completed with the support of the London Knowledge and Intelligence Team, Public Health England. Publisher Copyright: © 2015. Copyright: Copyright 2016 Elsevier B.V., All rights reserved.

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N2 - A large proportion of lung cancer patients in England are diagnosed through an emergency route, which is associated with poorer outcomes. Here, we investigated the association between emergency presentation and the odds of undergoing surgical resection and subsequent survival among lung cancer patients undergoing surgical resection as well as those who did not. Methods: Details of 93,783 lung cancers were extracted from the National Cancer Data Repository. For non-small cell lung cancer (NSCLC) patients we calculated odds ratios for undergoing surgical resection. Survival was assessed for resected NSCLC and for all other lung cancer patients in three different time intervals: short-term, intermediate and long-term. Results: Compared with those who did not, NSCLC patients presenting through an emergency route were less likely to undergo surgical resection (adjusted OR=0.22, 95% CI: 0.20-0.24). Patients who underwent surgical resection after an emergency presentation had lower survival in the intermediate period (adjusted HR=1.27, 95% CI: 1.06-1.54) and long term (adjusted HR=1.20, 95% CI: 0.99-1.45). Among all other lung cancer patients, those diagnosed through an emergency route had lower survival, particularly in the short-term (adjusted HR=3.54, 95% CI: 3.42-3.67), but the association remained in the intermediate (adjusted HR=1.66, 95% CI: 1.63-1.69) and long term (adjusted HR=1.10, 95% CI: 1.05-1.15). Conclusion: The reduced access to surgical resection and lower survival among lung cancer patients who present through an emergency admission, highlights the importance of ensuring symptoms are recognised early so that presentation as an emergency can be reduced.

AB - A large proportion of lung cancer patients in England are diagnosed through an emergency route, which is associated with poorer outcomes. Here, we investigated the association between emergency presentation and the odds of undergoing surgical resection and subsequent survival among lung cancer patients undergoing surgical resection as well as those who did not. Methods: Details of 93,783 lung cancers were extracted from the National Cancer Data Repository. For non-small cell lung cancer (NSCLC) patients we calculated odds ratios for undergoing surgical resection. Survival was assessed for resected NSCLC and for all other lung cancer patients in three different time intervals: short-term, intermediate and long-term. Results: Compared with those who did not, NSCLC patients presenting through an emergency route were less likely to undergo surgical resection (adjusted OR=0.22, 95% CI: 0.20-0.24). Patients who underwent surgical resection after an emergency presentation had lower survival in the intermediate period (adjusted HR=1.27, 95% CI: 1.06-1.54) and long term (adjusted HR=1.20, 95% CI: 0.99-1.45). Among all other lung cancer patients, those diagnosed through an emergency route had lower survival, particularly in the short-term (adjusted HR=3.54, 95% CI: 3.42-3.67), but the association remained in the intermediate (adjusted HR=1.66, 95% CI: 1.63-1.69) and long term (adjusted HR=1.10, 95% CI: 1.05-1.15). Conclusion: The reduced access to surgical resection and lower survival among lung cancer patients who present through an emergency admission, highlights the importance of ensuring symptoms are recognised early so that presentation as an emergency can be reduced.

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ER -

The effect of emergency presentation on surgery and survival in lung cancer patients in England, 2006-2008

Abstract

Bibliographical note

Keywords

UN SDGs

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