Lung cancer diagnosed following an emergency admission: mixed methods study of the management, outcomes and needs and experiences of patients and carers

Wilcock, Andrew and Crosby, Vincent and Hussain, Asmah and McKeever, Tricia M. and Manderson, Cathann and Farnan, Sarah and Freer, Sarah and Freemantle, Alison and Littlewood, Fran and Caswell, Glenys and Seymour, Jane (2016) Lung cancer diagnosed following an emergency admission: mixed methods study of the management, outcomes and needs and experiences of patients and carers. Respiratory Medicine, 114 . pp. 38-45. ISSN 1532-3064

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Abstract

Background

In the UK, although 40% of patients with lung cancer are diagnosed following an emergency admission (EA), data is limited on their needs and experiences as they progress through diagnostic and treatment pathways.

Methods

Prospective data collection using medical records, questionnaires and in-depth interviews. Multivariate logistic regression explored associations between diagnosis following EA and aspects of interest. Questionnaire responses with 95% confidence intervals were compared with local and national datasets. A grounded theory approach identified patient and carer themes.

Results

Of 401 patients, 154 (38%) were diagnosed following EA; 37 patients and six carers completed questionnaires and 13 patients and 10 carers were interviewed. Compared to those diagnosed electively, EA patients adjusted results found no difference in treatment recommendation, treatment intent or place of death. Time to diagnosis, review, or treatment was 7–14 days quicker but fewer EA patients had a lung cancer nurse present at diagnosis (37% vs. 62%). Palliative care needs were high (median [IQR] 21 [13–25] distressing or bothersome symptoms/issues) and various information and support needs unmet. Interviews highlighted in particular, perceived delays in obtaining investigations/specialist referral and factors influencing success or failure of the cough campaign.

Conclusions

Presentation as an EA does not appear to confer any inherent disadvantage regarding progress through lung cancer diagnostic and treatment pathways. However, given the frequent combination of advanced disease, poor performance status and prognosis, together with the high level of need and reported short-fall in care, we suggest that a specialist palliative care assessment is routinely offered.

Item Type: Article
Keywords: Lung cancer; Non-small cell lung cancer; Palliative care; Small cell lung cancer
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Cancer and Stem Cells
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine
Identification Number: 10.1016/j.rmed.2016.03.006
Depositing User: Eprints, Support
Date Deposited: 20 Nov 2017 13:16
Last Modified: 21 Nov 2017 02:50
URI: http://eprints.nottingham.ac.uk/id/eprint/48255

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