Cancer Outcome Metrics

The National Cancer Registration and Analysis Service (NCRAS) has developed two cancer outcomes indicators that can be refreshed on a quarterly basis: 

Official Statistics: Emergency Presentations 

The Emergency Presentation metric shows the estimated proportion of all malignant cancers* which present as an emergency. This is also an important driver of cancer outcomes: patients with cancers that present as an emergency suffer significantly worse outcomes. The recent 2015-2020 cancer strategy for England recommended that the proportion of emergency presentations should be regularly reported and reviewed. The metric estimates the true proportion of emergency presentations using first admissions to hospital as a proxy for diagnosis to allow more rapid reporting - see links below for further explanation.

The emergency presentation metric is now published on and is accessible via the emergency presentations of cancer collection page.

An interactive app is also hosted on the cancerdata website. The app contains interactive graphs showing the proportion of all malignant cancer diagnoses* which were emergency admissions for the selected geographic areas (Clinical Commissioning Groups or Cancer Alliances) or selected cancer type (England only). Confidence intervals are provided for quarterly proportion and 1-year rolling average proportion.

* Excluding non-melanoma skin cancer

Stage at Diagnosis

The Stage at Diagnosis indicator shows the percentage of all stageable cancers diagnosed that are recorded as presenting as a stage 1 and 2 as opposed to stage 3 or 4. Only cancers with a known staging value are included in the denominator, it is therefore staged cancers. This is presented at Cancer Alliance level with a 1-year rolling average (which combines the most recent year of data) but updated quarterly. Early stage at diagnosis is one of the most important factors that affect cancer outcomes, and promoting earlier stage at diagnosis is one of the key aims of the National Awareness and Early Diagnosis Initiative led by The Department of Health, Cancer Research UK, and Public Health England. This indicator is intended to measure progress towards the ambition that 75% of all stageable cancers will be diagnosed as stage 1 and 2 by 2028.

The experimental case-mix adjusted Stage at Diagnosis indicator is now published on and accessible via this page. This publication sets out and comments on stage at cancer diagnosis in Clinical Commissioning Groups in England for patients diagnosed in the period 2013 to 2018. Proportion of cancers diagnosed at an early stage are presented unadjusted and adjusted for case-mix (age, sex, cancer site and socio-economic deprivation).

Five collections of staging data are available in an interactive app on the cancerdata website. The collections include, the 1-year rolling average proportion of all stagable cancers diagnosed that are recorded as presenting as stage 1 and 2 by Cancer Alliance (CA) (75% ambition), case-mix adjusted percentage of cancers diagnosed at stage 1 and 2 by Clinical Commissioning Group (CCG), number of cancers by stage group by CCG, Sustainability and Transformation Partnership (STP) or CA for 21 cancer types, and number of cancers by stage group by deprivation for 21 cancer types.

Notes on interpretation

Emergency Presentation:

  • There are some cancers where emergency presentation may to be the most appropriate route to diagnosis, e.g. in children’s cancers where the first symptom of underlying cancer is likely to result in an emergency presentation regardless of whether there is a suspicion of cancer or not.
  • While the measure itself may correlate with improved survival where emergency presentations fall, this is not necessarily a direct cause and many other factors will be involved.
  • The denominator is all tumours identified from Inpatient HES and therefore does not include all diagnosed tumours registered by the NCRS. As a result, the results presented here may differ from publicly available results such as Routes to Diagnosis.
  • The indicator is not adjusted for case-mix. In particular CCGs with an older population can be expected to see a larger number of Emergency Presentations. CCGs with a larger number of lung cancers (due to smoking prevalence) or smaller number of breast cancers (due to broader socio-economic factors) can be expected to see a larger proportion of emergency presentations.
  • Smaller numbers at CCG level may result in large variability in the confidence intervals.

Stage at Diagnosis:

  • This indicator aligns with the cancer stage indicators in the Public Health Outcomes Framework (PHOF indicator 2.19) and the CCG outcomes Indicator Set (CCG OIS indicators 1.17 and 1.18) on the proportion of cancers diagnosed at stages 1 and 2. 
  • The % staged is important contextual information for understanding the % early stage, as a low % staged means the data quality of the indicator is low for this CCG.  Improvement in recording of stage continues to be part of the work programme for the NCRS; the % of cases staged continues to improve year on year.
  • Improvements in this indicator are likely to be the result of improved staging coverage, so inferences about changes over time can only be made if it is clear that staging completeness did not change significantly.
  • Note that not all cancers are included in the indicator. 
  • The case-mix of cancers diagnosed will impact on the proportion of early stage cancers.  For example breast cancer is far more likely to be diagnosed at an early stage than lung cancer, so areas with a high proportion of breast cancer will have better outcomes on this indicator in comparison with areas with a high proportion of lung cancer.
  • Smaller numbers at CCG level may result in large variability in the confidence intervals.

Detailed specifications describing the indicators are also available to download: