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

BACKGROUND: 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.