Lung cancer patients in New Zealand initially present to secondary care through the emergency department rather than by referral to a respiratory specialist.

Abstract

BACKGROUND: The previous study established that lung cancer patients in Auckland-Northland most commonly presented to secondary care through the emergency department (ED). AIM: To further explore the characteristics and presentation of cases presenting through EDs in Auckland. METHODS: Data were collected for all lung cancer cases (2004) in Auckland that initially presented to secondary care via ED RESULTS: Of (478) lung cancer cases diagnosed in Auckland in 2004, 170 cases (36%) presented via ED. ED presentation varied with tumour stage (p<0.0005), ethnicity (p=0.01), and DHB (p=0.004). Of the patients presenting to ED for whom records were available (159; 94%): 107 (67%) had respiratory symptoms; 66 (42%) were GP-referred; of these, 22 had had a CXR; 6 (4%) were already under respiratory surveillance; and 11 (6%) had previously been seen by secondary care regarding the presenting symptoms. All cases (except 1) were admitted. GP referral varied across DHBs (p=0.04) and ethnic groups (p=0.02). Age, gender, and tumour type were not associated with ED presentation. CONCLUSION: Lung cancer patients, especially those of Pacific ethnicity, commonly presented as emergencies, often by-passing primary care. This suggests barriers to, or within, primary care and further research is required to explore the reasons underlying these findings.