ESTRO 2025 - Abstract Book

S2316

Interdisciplinary – Health economics & health services research

ESTRO 2025

3372

Digital Poster Breaking barriers to early cancer detection: A multi-project study on emergency cancer diagnoses in the East of England. Emily C S Scott 1,2,3 , Sarah Bodsworth 3 , Benji Horwell 4 , Craig Johnson 4 , Peter J Hoskin 1,2,5 1 Oncology, Mount Vernon Cancer Centre, London, United Kingdom. 2 Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom. 3 Informatics Team, East of England Cancer Alliance, Ely, United Kingdom. 4 Health and Wellbeing Team, Behavioural Insights Team, London, United Kingdom. 5 Clinical Director, East of England Cancer Alliance, Ely, United Kingdom Purpose/Objective: Cancer diagnoses following an emergency presentation are associated with more advanced disease and poorer survival, especially among older, more deprived, and ethnic minority populations 1,2,3 . In the East of England (EoE), similar to the national average, 18% of cancer diagnoses follow an emergency presentation 1,2 . To address this, we conducted research to identify barriers to early diagnosis and implement solutions to reduce emergency presentations. Material/Methods: Five patients from the EoE who had received a diagnosis of cancer after an emergency presentation were recruited. Semi-structured interviews explored their reasons for seeking emergency care, symptom timelines, and barriers to earlier diagnosis. In addition, we surveyed 46 oncology staff within hospitals and 30 General Practitioners (GPs) using mixed-methods questionnaires to identify barriers to early cancer detection. Results: The study identified several key barriers to early cancer diagnosis. Cancer-related factors included the late onset and vague nature of symptoms, which complicate early detection. Patient-related issues encompassed limited symptom awareness, delayed help-seeking behaviours, and recurring non-specific symptoms. Notably, patients with strong social support, from friends or family who encouraged them to seek help, were more likely to pursue medical attention sooner. Clinician-related factors included challenges when considering cancer as a differential diagnosis, suboptimal assessment quality, and delayed referrals. Structural factors included: difficulties in accessing primary care; challenges with GP triage; remote GP appointments; imaging restrictions outside a hospital system; lack of continuity of care; diagnostic delays; delays in non-cancer appointments leading to overuse of cancer-related referrals; and disjointed working between primary and secondary care. GPs considered that lower gastrointestinal (16%), lung (13%), and haematological malignancies (11%) were the most frequently associated with emergency presentations. They also identified key barriers including late symptom onset (87%), limited patient awareness of cancer symptoms (83%), and persistent non-specific symptoms (80%). Patient interviews highlighted the impact of misattributed symptoms and challenges in accessing GP services, such as difficulties in navigating triage processes and articulating symptoms effectively during telephone consultations. Secondary care staff reported similar barriers, citing late symptom onset (85%), difficulty accessing GP appointments (78%), and limited patient awareness of cancer symptoms (70%). Conclusion: This study reveals critical barriers to early cancer diagnosis at patient, clinician, and structural levels. Overcoming these challenges necessitates targeted strategies to boost public awareness, improve clinical assessments, and streamline NHS care pathways. To address these issues, we will implement 11 distinct initiatives derived from the study, aimed at enhancing early cancer detection and reducing emergency presentations in the EoE.

Keywords: Emergency, Diagnosis, Cancer