Evidence map›Paper›PMID 29855264›Full record

ArticleBMC cancer2018

Trends in lung cancer emergency presentation in England, 2006-2013: is there a pattern by general practice?

Camille Maringe, Nora Pashayan, Francisco Javier Rubio, George Ploubidis, Stephen W Duffy, Bernard Rachet, Rosalind Raine

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In one paragraph

Article in BMC cancer, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006-2015.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Camille MaringeCancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK. camille.maringe@lshtm.ac.uk.ORCID http://orcid.org/0000-0002-8739-9565
Nora PashayanUniversity College London, Department of Applied Health Research, London, UK.
Francisco Javier RubioCancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK.
George PloubidisCentre for Longitudinal Studies, Department of Social Science, UCL - Institute of Education, University College London, London, UK.
Stephen W DuffyQueen Mary University of London, Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, London, UK.
Bernard RachetCancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK.
Rosalind RaineUniversity College London, Department of Applied Health Research, London, UK.

Funding

Cancer Research UK 18525Cancer Research UK C7923/A18525
6 · The paper itself

Abstract

backgroundEmergency presentations (EP) represent over a third of all lung cancer admissions in England. Such presentations usually reflect late stage disease and are associated with poor survival. General practitioners (GPs) act as gate-keepers to secondary care and so we sought to understand the association between GP practice characteristics and lung cancer EP.

methodsData on general practice characteristics were extracted for all practices in England from the Quality Outcomes Framework, the Health and Social Care Information Centre, the GP Patient Survey, the Cancer Commissioning Toolkit and the area deprivation score for each practice. After linking these data to lung cancer patient registrations in 2006-2013, we explored trends in three types of EP, patient-led, GP-led and 'other', by general practice characteristics and by socio-demographic characteristics of patients.

resultsOverall proportions of lung cancer EP decreased from 37.9% in 2006 to 34.3% in 2013. Proportions of GP-led EP nearly halved during this period, from 28.3 to 16.3%, whilst patient-led emergency presentations rose from 62.1 to 66.7%. When focusing on practice-specific levels of EP, 14% of general practices had higher than expected proportions of EP at least once in 2006-13, but there was no evidence of clustering of patients within practice, meaning that none of the practice characteristics examined explained differing proportions of EP by practice.

conclusionWe found that the high proportion of lung cancer EP is not the result of a few practices with very abnormal patterns of EP, but of a large number of practices susceptible to reaching high proportions of EP. This suggests a system-wide issue, rather than problems with specific practices. High proportions of lung cancer EP are mainly the result of patient-initiated attendances in A&E. Our results demonstrate that interventions to encourage patients not to bypass primary care must be system wide rather than targeted at specific practices.

Indexed as

AgedAged, 80 and overEmergency Medical ServicesEnglandFemaleGeneral PracticeHumansLung NeoplasmsMaleMiddle AgedNeoplasm StagingPractice Patterns, Physicians'Primary Health CareQuality Indicators, Health CareRegistriesSurveys and QuestionnairesEmergency presentationGeneral practiceLung cancer

Identifiers

PMID29855264
PMCPMC5984417

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.