Symptomatic presentation of cancer in patients diagnosed following emergency self-referral and prior general practice consultations

OBJECTIVES: Research indicates that approximately 70% of cancer cases diagnosed after emergency presentation involve patients who presented themselves to the emergency department. However, information on those who consulted primary care (PC) before self-referring as emergencies is lacking. We explored the characteristics, including the symptom signature of cancers and the cancer site case-mix of presenting symptoms, of patients who self-referred as emergencies after consulting PC (consulters), and compared them to those who self-referred but never consulted PC (nonconsulters). METHODS: Eligibility was restricted to patients diagnosed with 20 cancer sites over an 11-year period. The relative frequency of presenting symptoms was analyzed both across subgroup populations and by cancer site, as it was the range and relative frequency of cancers diagnosed following presentation with each symptom. Presenting symptoms were classified into alarm and nonalarm symptoms. RESULTS: The study comprised 1118 consulters and 987 nonconsulters. Certain cancers in both patient subgroups, notably pancreatic cancer, had a broad symptom signature, predominantly consisting of nonalarm symptoms, and patients presenting with nonalarm symptoms, especially consulters, were diagnosed with a wide variety of cancers. Pancreatic cancer in consulters presented with a wide range of symptoms, largely nonalarm symptoms, such as abdominal pain, documented in 28% (95% CI 24-33) of cases. Among consulters presenting with abdominal pain, 17% were diagnosed with colorectal, 41% with pancreatic, 11% with ovarian, and 31% with another 6 cancer sites. Conversely, the symptom signatures of other cancers, including breast cancer, were defined by one or two alarm symptoms, which were associated with specific cancer sites, particularly in nonconsulters. CONCLUSION: These findings advance the understanding and discussion of emergency presentations and support the formulation of policies and health programs to reduce emergency self-referrals. These include updated suspected cancer referral guidelines, diagnostic pathways for patients with nonalarm symptoms, cancer awareness initiatives, and safety-netting procedures.