Author of

• 10974

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  P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10975

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    P1.21-001 - Cancer Diagnosis in the Acute Setting (CADIAS): a study on behalf of the London Cancer Alliance (ID 86)

    09:30 - 09:30  |  Author(s): L. Forbes
    • Abstract

    Background
    The United Kingdom has poorer cancer survival rates than other comparable countries (EUROCARE and International Cancer Benchmarking Partnership studies). Furthermore, for some cancers stage at diagnosis is more advanced; largely explained by differences in one-year survival, a marker of later diagnosis. In 2012, the National Cancer Intelligence Network published a report as part of National Awareness and Early Diagnosis Initiative, Routes to Diagnosis. The key findings were that 24% of newly diagnosed cancer patients in England presented as emergencies. Tumour types most likely to present in this way included lung (39%). Emergency new cancer presentations were more likely in older patients and those from a more deprived background, and the relative one-year survival was significantly lower across nearly all tumour types. However, little is known about the reasons why so many patients present acutely with a potentially delayed diagnosis. Factors that lead to delayed diagnosis have been associated with the patient, the doctor and the healthcare system. Previous research in the area has been restricted by separating primary and secondary care, and data on the patient experience is limited. The CADIAS study is designed to examine the whole diagnostic pathway and consider improvements across all three domains.

    Methods
    This National Cancer Research Network approved study recruits patients who present to hospital as an emergency with a new diagnosis of lung or colorectal cancer. Data are collected from three sources, the patient, primary care and secondary care. The study aims to understand the whole diagnostic pathway; from first recognising a symptom to emergency presentation in secondary care, including the role of primary care; map the patient, clinical and organisational factors that contribute to an emergency new cancer diagnosis; and suggest ways to improve outcomes by identifying gaps in service provision and any opportunities to diagnose cancer earlier. Six hospitals within the London Cancer Alliance will aim to recruit 250-300 patients into the study (Chelsea and Westminster, Lewisham, Croydon, Hillingdon, St. Georges and Gyus and St. Thomas'). A small pilot study was conducted to confirm the feasibility of the recruitment methods and data collection tools, specifically the use of patient interviews across a relatively large scale and with a group of potentially unwell participants. This part of the study, which included research nurse training, was designed by the Promoting Early Cancer Presentation team at Kings College London.

    Results
    Data analysis of 9 patients and of the 1st cohort of nurse training demonstrated that the methods used and data collected is of the required quality and standard to open the study to full recruitment. CADIAS is now open across the remaining hospital sites and, at the time of abstract submission, a total of 19 patients had been enrolled.

    Conclusion
    Understanding the factors which contribute to an estimated 39% of lung cancer patients presenting as an emergency is key to improving cancer services and outcomes. This study brings the patient story together with data from primary care and secondary care to present a rich picture of this type of presentation and identifying any opportunities to diagnose cancer earlier.