More than half of lung cancers not diagnosed until after emergency department visit - report

Rowan Quinn for RNZ

More than half of all lung cancers are not diagnosed until after an emergency department visit - when it is often too late, a new report by the Cancer Control Agency shows.

And it found around half of many other cancers are not picked up until after an ED admission, with New Zealand having the highest rate of comparable countries.

When cancer is diagnosed only after an ED visit, the chances of dying or having serious health problems as a result were much higher.

"Patients being diagnosed through hospital emergency admissions often present with severe symptoms indicating advanced stage of disease and resulting in poorer outcomes," the report said.

CC 4.0 BY-SA / Graph created using data from McPhail et al 2022.
CC 4.0 BY-SA / Graph created using data from McPhail et al 2022. Photo credit: RNZ

Oncology professor Chris Jackson said the report showed patients were waiting too long to see specialists, or even their GPs, and it was too hard for doctors to get vital tests for many types of cancer.

"That is one of the fundamental reasons why New Zealanders have got a later stage of presentation of cancer and one of the primary reasons why our cancer survival rate is worse than comparable countries," he said.

There were two cancers with a higher rate of ED diagnosis than lung cancer - pancreas and brain or central nervous system - but they were more likely to have "quiet" symptoms or non-specific early symptoms, the report said.

Other cancers like lung, stomach and bladder had symptoms that should be detected in primary care, it said.

The rate of post-ED diagnosis for lung cancer was starkly worse for Pasifika patients at 72 percent, and Māori patients at 68 percent compared with Pākehā (48 percent).

And Māori and Pasifika people fared worse in many of the other cancers as well.

CC 4.0 BY-SA / Graph created using data from McPhail et al 2022.
CC 4.0 BY-SA / Graph created using data from McPhail et al 2022. Photo credit: RNZ

Professor Jackson said the government's new health targets should include cutting the high rate of diagnosis after an ED admission.

That might be politically difficult because progress could be slow but it was the right thing to do - and to properly fund everything that could be done to fix it, he said

Instead there was a "scarcity mentality" in the health system.

"We try and make do on the sniff of an oily rag and say 'mustn't grumble, just get on with it and do the best you can' or 'do more with less,'" Jackson said.

"Actually we need to change that and say if we want better outcomes you have to invest in the staff, in the infrastructure, in the treatments and the pathways."

Health Minister Shane Reti, who had met with the Cancer Control Agency to discuss the report, said the situation was unacceptable and the country must do better.

In a statement, Reti said the health system needed to improve.

"While this is certainly an important report system-wise, I'm also very aware that the story of late diagnosis is a human one," he said.

"When you're diagnosed in ED for an acute admission or as part of a routine planned care admission, you've generally come in for one cause and then it suddenly becomes cancer - that's devastating for anyone."

Reti did not respond to the calls to make cutting post-ED diagnosis a key target. But he said the government was focusing on improving screening, which would help.

It had already improved access to PET-CT diagnostic tests in the South Island, he said.