Emergency Presentations of Cancer: Quarterly Data, Q1 to Q3 2021/22 (Apr to Dec 2021)

This publication presents the total number of patients first seen as an inpatient in hospital in England (denominator); the number of these patients who present as an emergency (numerator), and the proportion of these patients who present as an emergency (numerator/denominator presented as a percentage). Both counts and proportions are presented, to enable a full understanding of any patterns or trends observed. The proportion should be used to assess the degree to which cancers present as an emergency, it is an easily interpretable indicator which can be compared across time periods and geographies. However, a high (or low) proportion of emergency presentations does not necessarily equate to a large (or small) number of patients who present as an emergency. Therefore, for context, counts should be used to assess the absolute burden of cancer on emergency services.

The timeline of the UK government COVID-19 lockdowns and restrictions in England should be considered when interpreting these statistics. To summarise, England entered the 1st national lockdown on 23rd March 2020 (restrictions started to ease on 10th May 2020), the 2nd national lockdown on 24th November (restrictions started to ease on 2nd December 2020), and the 3rd national lockdown on 6th January 2021 (restrictions started to ease on 8th March 2021). Most legal limits on social contact were removed in England on 19th July 2021, however facemasks and NHS COVID passes were re-introduced early December 2021 amid the spread of the Omnicron variant.

The first case of COVID-19 was detected in England in January 2020, therefore in order to assess whether the counts and proportions for the three most recent quarters of data (April to June 2021, July to September 2021, October to December 2021) have returned to pre-COVID levels, a comparison to the corresponding quarter in 2019 was undertaken. The corresponding quarter was used to consider any differences in seasonality. Similarly for the most recent 1-year rolling period (January to December 2021), a comparison to the same period in 2019 was undertaken.

Throughout the publication, a ‘significant’ difference (increase or decrease) and ‘no significant’ difference is used as shorthand for describing any (or lack of) statistically significant differences where a statistical test has been conducted.

The total number of cancer patients first seen as an inpatient in hospital in England rose from 63,559 during January to March 2021 to 70,392 during April to June 2021, to 70,793 during July to September 2021 and then decreased to 69,668 during October to December 2021.

In comparison to pre-COVID levels, the number of cancer patients was significantly higher for April to June (70,392 in 2021 compared to 69,022 in 2019), but was not significantly different for July to September (70,793 in 2021 compared to 70,957 in 2019) and October to December (69,668 in 2021 compared to 69,879 in 2019). This suggests that for the latest two quarters of data, the number of cancer patients first seen as an inpatient in hospital in England has returned to pre-COVID levels.

The number of emergency presentations rose from 13,326 during January to March 2021 to 14,734 during April to June 2021, then decreased to 13,911 during July to September 2021 and 13,084 during October to December 2021.

In comparison to pre-COVID levels, the number of emergency presentations was significantly higher for April to June (14,734 in 2021 compared to 13,551 in 2019), but was not significantly different for July to September (13,911 in 2021 compared to 13,667 in 2019) and October to December (13,084 in 2021 compared to 12,834 in 2019). This suggests that for the latest two quarters of data, the number of emergency presentations in England has returned to pre-COVID levels.

Figure 1 shows the total numbers of cancer patients first seen in hospital during the three most recent quarters (April to June 2021, July to September 2021 and October to December 2021) have returned to levels seen prior to the COVID-19 pandemic (pre-April to June 2020). A similar trend in the number of non-emergency presentations is also shown. The number of emergency presentations has stayed relatively consistent over time.

The proportion of new cancer patients presenting as an emergency has decreased from 21.0% during January to March 2021 to 20.9% during April to June 2021, 19.7% during July to September 2021 and 18.8% during October to December 2021 (Figure 2).

In comparison to pre-COVID levels, the proportion of new cancer patients presenting as an emergency was significantly higher for April to June (20.9% in 2021 compared to 19.6% in 2019), was not significantly different for July to September (19.7% in 2021 compared to 19.3% in 2019) and was significantly higher for October to December (18.8% in 2021 compared to 18.4% in 2019). Although the proportions for October to December in 2021 compared to 2019 was significantly higher, the absolute difference in proportions was small (0.4%), suggesting that the proportions are almost at pre-COVID levels.

The increase in the proportion of emergency presentations seen in 2020 and early 2021 was likely driven by the decrease in non-emergency presentations, and not by a substantial increase in the number of emergency presentations.

Figure 2 shows that in England, the 1-year rolling proportion of cancer patients who first presented as an emergency has been gradually falling over the five years prior to the COVID-19 pandemic, from 19.9% in April 2016 to March 2017 to 18.8% in April 2019 to March 2020.

The 1-year rolling proportion then increased for each 1-year rolling period up until April 2020 to March 2021 (22.9%) and has been decreasing for the three most recent 1-year rolling periods; July 2020 to June 2021 (21.5%), October 2020 to September 2021 (20.3%), and January to December 2021 (20.1%).

However, the 1-year rolling proportion during the three most recent periods remained significantly higher than during the corresponding 1-year rolling periods before the COVID-19 pandemic; July 2018 to June 2019 (19.0%), October 2018 to September 2019 (19.1%), and January to December 2019 (19.1%).