Richard Simcock: Emergency Diagnosis Remains a Major Challenge in Ovarian Cancer Care

Richard Simcock/LinkedIn

Richard Simcock: Emergency Diagnosis Remains a Major Challenge in Ovarian Cancer Care

Richard Simcock, Chief Medical Officer at Macmillan Cancer Support, shared on LinkedIn:

“Having cancer diagnosed following an emergency admission is bad. It is associated with late stage, poorer survival and poor experience

The Northern Ireland 2022-2032 Cancer Plan highlights

the significant survival differences seen by route to diagnosis, with three-year survival highest for screen-detected cancers at 97% compared to three-year survival of 21% for those presenting as an emergency.

Georgia Zachou and the team at NATCAN have this month published useful data in BMJ Oncology to understand the extent of the problem in England with respect to Ovarian Cancer.

The data looks at 2017-2021 registry figures and assesses characteristics of those people diagnosed with an ovarian cancer within 28 days of an emergency admission. The figure was shockingly high with 2 in 5 women (40.3 %) of the 28204 included women diagnosed after emergency attendance. It is the broadest population based study of this problem yet published, and it starkly illustrates variations in care.

Emergency admission was seen more commonly:

-In severely frail people (68.6% of those with worst SCARF frailty score compared to 29.2% of those with lowest score)

In people with comorbidities (67.6% in people with 3 or more recorded comorbidities compared to 34.8% in those with none)

In those from the most deprived quintiles of neighbourhoods (44.2% compared to 37.8% in the least deprived)

There were also statistically significant differences showing higher rates in younger women (42.7% of the 490 people aged 18-29 diagnosed as emergencies) and in older people (54.9% of the 5379 people aged over 80). There were no observed differences by ethnicity.

Ovarian cancer is notoriously difficult to diagnose; presenting symptoms can mimic many benign conditions and there is no proven early screening pathway.

Macmillan Cancer Support have useful information and videos on symptoms.

These data points also do not tell us about any primary care contacts these women may have had. What the data powerfully shows is a need for increased and concerted effort on improving pathways but provide some focus on which patient groups may most benefit from intervention.

The NHS England Cancer Plan has an ambition to diagnose 75% of cancers at Stage 1 or 2 by 2035. In this study the number of ovarian cancer diagnosed at Stage 1 and 2 was 29.6% and only 13.7% in those diagnosed as an emergency.

Scotland’s 10-year Cancer Strategy 2023-2033 puts numbers on an ambition to reduce late-stage cancer diagnoses (Stages 3 and 4) from 42% to 24%.

Too many people are being diagnosed late and these data clearly show that deprivation, comorbidity and age all reduce the chance of this disease being caught at a more treatable stage. There is much work to do here.”

Title: Ovarian cancer diagnosis within 28 days after an emergency admission to hospital: national population-based study of patient risk factors and cancer characteristics using routinely collected data in England

Authors: Georgia Zachou, Rui Wu, Andrew Hutchings, Jan van der Meulen, Ipek Gurol-Urganci, Agnieszka Michael, Sudha Sundar

Read the full article.

Other articles about Ovarian Cancer on OncoDaily.