Poor people more likely to get late cancer diagnosis

Patients from the poorest backgrounds are around 50% more likely than the well-off to discover they have cancer after attending hospital as an emergency case.

One in seven of all cancers in Ireland is diagnosed when a patient presents as an emergency with acute symptoms, but that rate varies depending on income.

According to the National Cancer Registry, which studied trends over five years, the most deprived 20% of the population are on average 54% more likely to present as an emergency than the wealthiest 20%. Depending on the type of cancer, the difference ranged from 25%-67%.

The impact of income is also evident from the settings where emergency cases appear. The proportion of cancers presenting as emergencies is 14.8% in the designated public cancer centres, 22% in other public hospitals and only 2.9% in private hospitals.

Registry director Kerri Clough-Gorr, a professor of cancer epidemiology at University College Cork, said some cancers by their nature are more likely to give rise to emergency presentations.

“There are some cancers like pancreatic cancer that don’t have a lot of symptoms and they can be there for quite a while before a patient becomes acutely ill quite quickly,” she said.

However, Prof Clough-Gorr said the overall picture suggests that many people are unaware of the symptoms of cancers or that they are avoiding going to their GPs to have symptoms investigated. It was also possible that it reflects those people who do not avail of public screening programmes. The resulting emergencies are more likely in low-income groups.

“You don’t want people presenting as an emergency,” said Prof Clough-Gorr. “It’s much harder on the patient because the symptoms are acute, it’s a more expensive form of care and it’s also much more likely that it’s a late diagnosis which is never good when we’re talking about cancer.”

She said there is a need to make people aware of what to watch out for.

“There are cancers like lung cancer where people may have gotten used to a persistent cough so they don’t do anything about it,” she said. “We need to shift people’s thought processes around this — get them thinking: ‘If I have this problem and it’s not going away, I need to get it checked out.’ ”

One in three cases of pancreatic cancer present as emergencies; as do one in four cases of lung and ovarian cancer; and one in five cases of colon cancer. People with prostate, breast and melanoma skin cancer are proportionately least likely to present as emergencies but because these are the most common cancers, the actual numbers of patients is still significant.

It is not clear what proportion of cases became emergencies because of waiting lists for diagnostic tests in public hospitals.

A fuller study of emergency presentations is underway.


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