Evidence map›Paper›PMID 31655434›Full record

ArticleCancer epidemiology2019

Population trends in emergency cancer diagnoses: The role of changing patient case-mix.

A Herbert, S Winters, S McPhail, L Elliss-Brookes, G Lyratzopoulos, G A Abel

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Cancer epidemiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
0.5field-weighted citation impact, top 31% of its field
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

11 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. Article
  9. Emergency presentations of head and neck cancer: Our experience in the wake of the COVID-19 pandemic.Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery · 2021
    Article
  10. The Sirenic Links between Diabetes, Obesity, and Bladder Cancer.International journal of molecular sciences · 2021
    Review
  11. 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

6 authors at 4 institutions in 1 country.

A HerbertMRC Integrative Epidemiology Unit Bristol Medical School University of Bristol Bristol UK; Epidemiology of Cancer and Healthcare Outcomes (ECHO) Group, Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK.
S WintersNational Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK.
S McPhailNational Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK.
L Elliss-BrookesNational Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK.
G LyratzopoulosEpidemiology of Cancer and Healthcare Outcomes (ECHO) Group, Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK; National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK; Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK. Electronic address: y.lyratzopoulos@ucl.ac.uk.
G A AbelUniversity of Exeter Medical School, Exeter, UK.
Public Health England · GBUniversity College London · GBNational Cancer Registration Service · GBUniversity of Exeter · GB

Funding

Cancer Research UK 18180Cancer Research UK C18081/A18180Cancer Research UK C8640/A23385
6 · The paper itself

Abstract

backgroundDiagnosis of cancer through an emergency presentation is associated with worse clinical and patient experience outcomes. The proportion of patients with cancer who are diagnosed through emergency presentations has consequently been introduced as a routine cancer surveillance measure in England. Welcome reductions in this metric have been reported over more than a decade but whether reductions reflect true changes in how patients are diagnosed rather than the changing case-mix of incident cohorts in unknown.

methodsWe analysed 'Routes to Diagnosis' data on cancer patients (2006-2015) and used logistic regression modelling to determine the contribution of changes in four case-mix variables (sex, age, deprivation, cancer site) to time-trends in emergency presentations.

resultsBetween 2006 and 2015 there was an absolute 4.7 percentage point reduction in emergency presentations (23.8%-19.2%). Changing distributions of the four case-mix variables explained 19.0% of this reduction, leaving 81.0% unexplained. Changes in cancer site case-mix alone explained 16.0% of the total reduction.

conclusionChanges in case-mix (particularly that of cancer sites) account for about a fifth of the overall reduction in emergency presentations. This would support the use of adjustment/standardisation of reported statistics to support their interpretation and help appreciate the influence of case-mix, particularly regarding cancer sites with changing incidence. However, most of the reduction in emergency presentations remains unaccounted for, and likely reflects genuine changes during the study period in how patients were being diagnosed.

Indexed as

Emergency Service, HospitalFemaleHumansMaleNeoplasmsCase-mixDiagnosisEmergencyInequalitiesNeoplasmPublic health

Identifiers

PMID31655434
PMCPMC6905147
OpenAlexW2976536400

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.