TOPLINE: 

Among patients with lung cancer, those diagnosed through an emergency presentation had lower rates of prediagnostic consultations and chest imaging than those diagnosed via urgent or routine referrals from GPs.

METHODOLOGY:

• Researchers assessed the use of prediagnostic healthcare among patients diagnosed via an emergency presentation or through referred routes.
• They identified 4473 patients aged 30-99 years with lung cancer from a UK population-based linked English primary care data source (2007-2018), of whom 1491 were diagnosed via an emergency presentation, 1259 through urgent referral, and 1026 through routine referral.
• Diagnoses made through emergency visits were compared with those made through two main referral pathways — urgent referrals for suspected cancer (or "two-week wait" referrals) and routine referrals from a GP.
• The analysis included monthly prediagnosis rates of consultations for any clinical reason, consultations for selected symptoms, and chest imaging, stratified by diagnostic route (emergency presentation, routine referral, or urgent referral).
• Monthly rates of primary care consultations and imaging for selected symptoms were analysed over the 12 months preceding diagnosis.

TAKEAWAY:

• Diagnostic windows for consultations and imaging were similar or shorter for patients diagnosed via emergency presentation vs those diagnosed via referral.
• Prediagnostic chest imaging rates were lower in patients diagnosed via an emergency presentation than in those diagnosed through routine referrals (adjusted incidence rate ratio [aIRR], 2.45; 95% CI, 1.97-3.05) or urgent referrals (aIRR, 1.95; 95% CI, 1.56-2.25).
• Prediagnostic consultation rates for respiratory symptoms were higher among patients diagnosed through routine referrals (aIRR, 1.72; 95% CI, 1.51-1.96) or urgent referrals (aIRR, 1.62; 95% CI, 1.42-1.84) than among those diagnosed via an emergency presentation.
• Patients diagnosed via an emergency presentation had lower adjusted prediagnostic consultation rates for cough than those diagnosed through referred routes (aIRR, 1.90; 95% CI, 1.58-2.30 for routinely referred patients and aIRR, 1.94; 95% CI, 1.61-2.33 for urgently referred patients vs patients diagnosed via an emergency presentation).

IN PRACTICE:

"Improving referral pathways and post-imaging follow-up may support earlier diagnosis across routes, though fewer prediagnostic contacts among emergency-diagnosed patients limit opportunities to intervene compared with referred route patients," the authors wrote.

"Comparing prediagnostic healthcare use between emergency-diagnosed and referred lung cancer patients revealed no clear aetiological targets to reduce emergency diagnosis. Instead, our findings suggest potential to expedite diagnosis across all groups. In particular, through improved management of non-specific symptoms, timely follow-up of imaging, and greater access to chest CTs for suspected cancer," they added.

SOURCE:

The study was led by Marta Berglund, MSc, of the Department of Behavioural Science and Health at the Institute of Epidemiology and Health Care, University College London in London, England. It was published online on December 04, 2025, in the British Journal of General Practice.

LIMITATIONS: 

The reliance on coded data rather than free text limited the analysis, and imaging results were unavailable. The study focused solely on patients with lung cancer, without examining healthcare use patterns in a reference population, and the findings may have been influenced by confounding factors.

DISCLOSURES:

The study received funding from the National Institute for Health Research Policy Research Programme, the Cancer Research UK Project Award, and the International Alliance for Cancer Early Detection. One author reported receiving personal fees from GRAIL Inc for Independent Data Monitoring Committee membership unrelated to this study, and another author reported receiving personal funding from the British Liver Trust in 2023 for an unrelated data consultancy project.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.