The COVID-19 pandemic disrupted normal pathways to cancer diagnosis, particularly for screening and non-acute symptomatic patients. While reductions in overall cancer diagnoses have been reported elsewhere, any differential effects on emergency presentations, which are associated with poorer outcomes, have not been described.
Cross-sectional descriptive study from 2015-2021, based on International Cancer Benchmarking Partnership methods, where emergency route to diagnosis is defined as presenting as an emergency admission in the 30 days prior to cancer incidence date. Acute hospital records and cancer registrations were individually linked. Includes all individuals with a new diagnosis of specific cancers on the national cancer registry.
All cancers included showed reductions in non-emergency diagnoses in 2020, with varying recovery in 2021. The largest reductions in non-emergency diagnoses of about a third were for colorectal and cervical cancers in 2020. Non-emergency diagnoses of prostate cancer remained lower but upper GI higher in 2021. Emergency routes to diagnosis were significantly higher in 2020 for breast, cervical, colorectal and upper GI cancers and were higher in 2021 for breast and cervical cancers. The absolute magnitude of reductions in non-emergency diagnoses was greater than any increases in emergency diagnoses.
In 2020, there were large reductions in numbers of cancers diagnosed through non-emergency pathways in Scotland, while those diagnosed via emergency routes fell only for prostate cancer. Some effects persisted or emerged through 2021. It is likely that opportunities to diagnose cancers in a favourable, elective manner have been lost. Further work is needed to describe outcomes among these patients.
Journal of cancer policy. 2024 Sep 05 [Epub ahead of print]
Calum Purdie, Gavin Rc Clark, David A Cameron, Russell Petty, Paramananthan Mariappan, Janet Graham, Kevin A Burton, David S Morrison
Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB. Electronic address: ., Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB., Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital Campus, Crew Road, Edinburgh, Scotland, EH4 2XU., Ninewells Hospital and Medical School, Dundee, Scotland, DD1 9SY., Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, Scotland, EH4 2XU., Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, Scotla3nd, G12 0YN., Department of Gynaecological Oncology, Glasgow Royal Infirmary, PRMH Building, 16 Alexandra Parade, Glasgow, Scotland, G31 2ER., School of Health & Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, Scotland, G12 8TB.