Emergency presentations: time to ‘level up’ Yorkshire

Research has shown England compares poorly to other countries when it comes to emergency diagnosis of cancer. But our analysis reveals that Yorkshire fares even worse. We look at the data and how we can stop people in our region dying early from cancer.

A cancer diagnosis often begins with someone going to their GP with symptoms, then being referred for further tests at a hospital.

But for some people, their symptoms are so severe or have developed so quickly that they have to go to A&E and are later diagnosed with cancer. This is known as ‘emergency presentation’.

People whose cancers are diagnosed in this way are often diagnosed at a late stage and have a lower chance of survival.

A study published earlier this year highlighted differences between England and other countries in their rates of emergency presentations for some cancers - and it provided another reminder that Yorkshire fares poorly in many aspects of cancer diagnosis and survival compared to the rest of the country.

The research was part of the International Cancer Benchmarking Partnership (ICBP) – a project which has been running since 2009 to compare cancer outcomes between a group of similar developed countries. Regions from seven countries are currently taking part: Norway, Denmark, Canada, Australia, New Zealand, Ireland, and the UK.

The ICBP releases new research findings regularly, and for the UK, the results are often bad news. They often show that the UK, and England in particular, is among the worst performing countries in this group when it comes to cancer survival.

In this research, published in April 2022, the ICBP team looked at emergency presentations for eight different types of cancer which are often diagnosed through this route: cancers of the oesophagus, stomach, colon, rectum, liver, pancreas, lung, and ovaries.

Among the findings, the team revealed, again, that England is towards the bottom of the league tables on many measures, including higher rates of emergency presentations, and higher rates of deaths from cancers diagnosed this way.

As poor as England appears to compare to other countries, our own analysis reveals that Yorkshire as a region fares even worse when it comes to emergency presentations and cancer survival.

As an example, let’s look at two cancers included in the ICBP study – lung cancer and bowel cancer (which includes both colon and rectal cancers combined).

First, we’ll look at the rate of emergency presentations – defined as a diagnosis of cancer within 30 days after attending A&E.

Looking at data for Yorkshire for a similar time period to the ICBP study, we estimate that 36.1% of lung cancers – or roughly 1 in 3 – were diagnosed through an emergency presentation. This is higher than the average for England as a whole (34.7%), according to data from the ICBP study. This is also significantly worse than the best performing partners in the ICBP study – by almost 10%.

For bowel cancer, an estimated 24.7% were diagnosed through emergency presentation in Yorkshire – or roughly 1 in 4 people. This is also worse than England’s average at 24.1% and again significantly higher than the best performing areas.

When looking at one-year survival – the percentage of people who survive for one year or more after diagnosis - both England and Yorkshire fall behind.

In Yorkshire, one-year survival for lung cancer is 39.6%. This is slightly higher than the rest of England (39.4%) and the UK (39.0%). However, all these figures are lower than those of New Zealand, Denmark, Norway, Canada, and Australia.

To put these percentages into context, if Yorkshire had the same survival rate as Australia (the best performing country with a one-year survival of 49.2%), then we could expect 411 fewer lung cancer deaths each year in Yorkshire.

For bowel cancer, one-year survival in Yorkshire is 78%, lower than the rest of England (78.8%) and the UK (79.3%) – and all these figures are significantly lower than New Zealand, Denmark, Norway, Canada, and Australia.

If Yorkshire had a similar survival rate to Australia (87.7%), we could expect 340 fewer people losing their lives to bowel cancer each year in our region.

So how do we reduce the number of people diagnosed by emergency presentation?

It’s likely that a combination of differences across whole healthcare systems are to blame for the concerning variation between Yorkshire and the rest of the UK, and the world.

Australia has better outcomes due to the high proportion of cancers diagnosed early - which they put down to the management of referral and screening services.

Australia has the best availability of imaging services for the types of cancer looked at in the ICBP report.

The chief executive of Cancer Council Australia, Prof Sanchia Aranda, says that: “In Australia our primary care practitioners can refer patients for a full range of investigation, whereas in places like the UK that’s mediated through a secondary referral to a specialist.

“So we can get it done much earlier, and either rule out cancer or make a directed referral.”

Emergency presentations need addressing urgently - and thanks to your donations, Yorkshire Cancer Research is funding research and services to help reduce delays in diagnosis and treatment.

This includes projects like the Leeds Lung Health Check and the Bowel Cancer Improvement Programme, which could serve as models for how to address these issues elsewhere in the UK.

But to reduce emergency presentations and close the survival gap – both within the UK and globally – the UK Government and local health leaders must learn lessons of best practice from abroad and locally.

We need to make sure that Yorkshire and the rest of the UK have some of the best survival rates in the world – because no one should have less of a chance of a long life just because of where they live.