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

Wilcock, Andrew; Crosby, Vincent; Hussain, Asmah; McKeever, Tricia M.; Manderson, Cathann; Farnan, Sarah; Freer, Sarah; Freemantle, Alison; Littlewood, Fran; Caswell, Glenys; Seymour, Jane


Andrew Wilcock

Vincent Crosby

Asmah Hussain

Professor of Epidemiology and Medical Statistics

Cathann Manderson

Sarah Farnan

Sarah Freer

Alison Freemantle

Fran Littlewood

Glenys Caswell

Jane Seymour



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.

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.

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.

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.


Wilcock, A., Crosby, V., Hussain, A., McKeever, T. M., Manderson, C., Farnan, S., …Seymour, J. (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, 38-45.

Journal Article Type Article
Acceptance Date Mar 9, 2016
Online Publication Date Mar 14, 2016
Publication Date 2016-05
Deposit Date Nov 20, 2017
Publicly Available Date Nov 20, 2017
Journal Respiratory Medicine
Print ISSN 0954-6111
Electronic ISSN 1532-3064
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 114
Pages 38-45
Keywords Lung cancer; Non-small cell lung cancer; Palliative care;Small cell lung cancer
Public URL
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