Cancer patients only diagnosed when they end up at A&E
That’s exactly what happened to Emmerdale’s Leah Bracknell. Tragically, it’s far from unusual
LAST week, it was reported that former Emmerdale actress Leah Bracknell was diagnosed with advanced lung cancer after turning up at A&E struggling to breathe. Leah, a 52-year-old mother of two who played Zoe Tate in the TV soap, needed a litre of fluid drained from her chest — it was then that the inoperable tumour was discovered.
Hers is not an unusual case. one in five of all cancers is diagnosed only once it has caused symptoms that require emergency treatment, such as fluid build- up, bleeding or a bowel obstruction.
sixty-thousand cancer patients a year are diagnosed in this way and, often, the cancer is by then advanced.
This late diagnosis can dramatically reduce patients’ chances: the one-year survival rate for lung cancer that has spread (stage 4 cancer) is just 17 per cent. If diagnosed at the earliest stage — stage 1, where the cancer is contained to the organ affected — 83 per cent will be alive a year later. And it’s a similar story with virtually every other cancer.
‘Britain has the worst cancer survival rates in western Europe and a lot of this is due to cancer being diagnosed late, often after an emergency presentation,’ says Professor karol sikora, a leading Uk oncologist and former chief of the World Health organisation cancer programme.
How bad the situation is was laid bare by a study published in the British Journal of Cancer last week, which found that 35 per cent of colon cancers and 15 per cent of rectal cancers were diagnosed when the patient sought emergency treatment for their symptoms.
Last week’s study also found that one in five cases of bowel cancer diagnosed in emergencies had red flag symptoms that should have been spotted earlier.
In most cases, though their symptoms weren’t typical, the patients had visited their doctor ‘multiple times during the months leading up to their diagnosis’, says Cristina Renzi, the Cancer Research Uk scientist at University College London who led the study.
‘These could represent opportunities to diagnose the cancer earlier.’
Jason Provette’s late diagnosis with bowel cancer is a typical example. The 46-year-old construction site manager was diagnosed with stage 3 bowel cancer — it had started to spread — in may 2012, after suffering excruciating abdominal pains and being sent to A&E with suspected appendicitis.
Jason, who lives in Findon, West sussex, with his wife kelly, 44, says: ‘Before I was diagnosed, I had to pull over into a lay-by a few times, as I was doubled over with pain. I put my head on the steering wheel as sweat ran down my forehead.
‘ The cramping pains would last anything from ten to 60 seconds and I was having them up to 50 times a day.’
Jason’s GP said it was trapped wind and prescribed peppermint oil, which did nothing. ‘I went back three times in four weeks and saw a different doctor each time. They all said it was wind, until my last visit, when the doctor found I had tenderness on the right lower side of my abdomen. He said it looked like appendicitis and sent me to A&E.’
Tests revealed he, in fact, had a tumour partly blocking his bowel and he underwent urgent surgery. Four years on, he remains all clear and counts himself ‘very lucky’.
A patient’s chances of their cancer being spotted early can be a postcode lottery.
Figures published last week by Public Health England revealed huge regional variations, with 87 per cent of local authorities found to be providing inadequate care: on average, only 50.7 per cent of cancers were diagnosed early.
ASPOKESMAN for NHS England said cancer care was the ‘best it’s ever been’, but said it had set ‘stretching goals to save thousands more lives by 2020’. The spokesman added that an extra £15 million was being invested in early diagnosis and setting up Cancer Alliances to drive leadership across local areas and drive improvement.
Professor sikora suggests a number of reasons for the Uk’s poor performance. ‘one is that British people are stoical and don’t like to make a fuss, and so often leave it too late to see their GP.
‘secondly, access to GP appointments is not that easy. Thirdly, although since 2000 we’ve had this national Cancer Plan for faster referrals for investigation, the NHS is overstretched and feels like Heathrow on a busy day.
‘There are serial delays in getting diagnostic tests, results and then referrals to the relevant specialists. only 25 per cent will get their cancer diagnosed via the two-week faster referral route,’ he says.
Professor sikora adds that what’s needed is investment in standalone cancer diagnostic centres such as those in Europe, which speed up investigations. ‘We need about 200, but the NHS is like an aircraft carrier and it can be difficult to change course.’
Deborah Alsina, chief executive of the charity Bowel Cancer Uk, said part of the problem was that changes following the reform of the NHS in England four years ago, such as dismantling the national Cancer Action Team, meant cancer was ‘de-prioritised’. ‘Thankfully, cancer is back on the agenda,’ she says.
Bowel cancer can be difficult to diagnose, she adds, as symptoms can be confused with other bowel conditions, but the introduction of a potentially more sensitive screening test, the faecal immunochemical test (FIT), in the next two years will help.
However, she says that more money is needed for endoscopy services (the main tool for diagnosing bowel cancer, using a tiny camera). ‘Until this happens, people will continue to die needlessly from a disease that can be successfully treated.’
But there is no doubt that patients delay their diagnosis by seeking help only when it’s an emergency. Charlotte Dawson, head of the nurse advisory service at charity Beating Bowel Cancer, says while Brits laugh about toilet humour, they ‘still feel embarrassed talking about bowel symptoms’.
Professor sikora adds: ‘If someone has had a symptom
such voice moreneed to as or than geta abdominalcoughit two checked weeks,or a pain hoarseout.’ theyfor one Alex of Feigenbaum,those who didn’t.59, was He was lung after A&E, himselfnight recalls‘I’d diagnosedcancerbeen sweatsbut beingAlex,to admits blame. havinga twofor admittedwith garageoverhe years drenching advancedhasa owner year,’ago, onlyvia who Edgware,bathed lives in with London.sweat, wife but Tony,‘I’d refusedwake67, in to I wasgo to sweatingthe doctor. becauseI thoughtI was overweight.six monthsI was before wrong.’ his diagnosis, Alex, a former smoker, developed a persistent cough that woke him at night and caused chest pain. He’d also lost weight — at 5ft 10in, he went from 16st 7lb to 13st 12lb in a year.
‘I left it a few months then, one night, my breathing was so bad that I went to A&E.’
He was X- rayed and diagnosed with a chest infection and given antibiotics. Ten days later, he went back. ‘This time, I was told to take ibuprofen for the chest pain when I coughed. Two weeks later, I saw my GP and he insisted I go to hospital.’
Alex was told he had stage 4 lung cancer — it had spread to his lymphatic system. That was 22 months ago.
He had one course of chemotherapy and is now being treated with an immunotherapy drug. He says: ‘I’ve had excellent NHS care. Looking back, I wish I’d gone to the doctors sooner, but I had no idea night sweats were a sign of cancer.’