Emergency Presentations of Cancer: Quarterly Data, Q4 2021/22 to Q2 2022/23 (January to September 2022)

This publication presents the total number of patients first seen as an inpatient in hospital in England; the number of these patients who present as an emergency, and the corresponding proportion of these patients who present as an emergency.

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.

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. Counts should be used to assess the absolute burden of cancer on emergency services.

The timeline of the Covid-19 lockdowns and restrictions in England should be considered when interpreting these statistics.

England entered the first national lockdown on 23 March 2020 and restrictions started to ease on 10 May 2020. The second national lockdown started on 24 November and restrictions eased on 2 December 2020. The third national lockdown started on 6 January 2021 and restrictions eased on 8 March 2021. Most legal limits on social contact were removed in England on 19 July 2021.

To assess whether the counts and proportions for the three most recent quarters of data (January to March, April to June and July to September 2022) have returned to pre-Covid levels, a comparison with the corresponding quarters in 2019 was undertaken, considering any differences in seasonality. Similarly for the most recent 1-year rolling periods (April 2021 to March 2022, July 2021 to June 2022 and October 2021 to September 2022), a comparison to the same period in 2018-2019 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.

From January to March 2022 to July to September 2022, the total number of cancer patients first seen as an inpatient in hospital in England increased from 69,423 to 71,589.

In comparison with pre-Covid levels, the number of cancer patients was significantly higher for January to March, April to June and July to September in 2022 compared to 2019.

From January to March 2022 to July to September 2022, the total number of emergency presentations in England decreased from 13,673 to 13,193. Patients with a new diagnosis of cancer who first present as an emergency typically suffer poorer outcomes which require more intensive and costly treatments.

In comparison with pre-Covid levels, the number of cancer patients was significantly higher for January to March, not significantly different for April to June, and significantly lower for July to September in 2022 compared to 2019.

Figure 1 shows that the total number of cancer patients first seen in hospital during the three most recent quarters (January to March 2022, April to June 2022 and July to September 2022) have returned to levels seen prior to the Covid-19 pandemic. A similar trend in the number of non-emergency presentations is also shown.

Figure 2 illustrates the proportion of new cancers presenting as an emergency gradually decreased from 19.0% in October to December 2017 to 17.9% in January to March 2020. This was followed by a sharp increase to 27.7% in April to June 2020, around the beginning of the Covid-19 pandemic. The quarterly proportion decreased between April to June 2020 and October to December 2020. A small increase in the quarterly proportions was seen for January to March 2021 and April to June 2021. These variations are closely correlated with the national lockdowns introduced to alleviate the pressure of Covid-19 on the NHS.

For the most recent three quarters, from January to March 2022 to July to September 2022, the proportion of emergency presentations in England decreased from 19.7% 18.4%.

The 1-year rolling proportion of cancer patients presenting as an emergency gradually decreased in the periods prior to the Covid-19 pandemic, from 19.5% in January to December 2017 to 18.8% in April 2019 to March 2020.

The 1-year rolling proportion then increased until April 2020 to March 2021 (22.9%) and has been gradually decreasing for the three most recent 1-year rolling periods; April 2021 to March 2022 (19.8%), July 2021 to June 2022 (19.4%) and October 2021 to September 2022 (19.1%).

Comparison to pre-Covid levels, quarterly proportion

In comparison to pre-Covid levels, the proportion of new cancer patients presenting as an emergency was significantly higher for January to March, not significantly different for April to June, and significantly lower for July to September in 2022 compared to 2019.

Comparison to pre-Covid levels, 1-year rolling proportion

In comparison with pre-Covid levels, the 1-year rolling proportion of new cancer patients presenting as an emergency in England was not significantly different for October 2021 to September 2022 compared to October 2018 to September 2019, and significantly higher for April 2021 to March 2022 compared to April 2018 to March 2019 and July 2021 to June 2022 compared to July 2018 to June 2019.