This document reviews the evolution and current challenges of the Acute Oncology Service (AOS) within the broader context of urgent and emergency care in the UK.

It highlights how AOS, originally designed as an inpatient advisory service, has become misaligned with recent healthcare trends favouring admission avoidance and early discharge. While some hospitals have progressed towards more responsive cancer assessment and same day discharge, many still struggle to adapt to new strategic priorities.

The pressures facing urgent and emergency departments, compounded by inefficient patient flow and limited inpatient capacity, have prompted national transformation plans focusing on improved care coordination and alternative pathways such as Urgent Community Response and Same Day Emergency Care.

Despite cancer accounting for a modest proportion of emergency department attendances, cancer patients are more likely to be admitted, often for short stays, due to a tendency to assess through admission rather than coordinated outpatient management. The limitations of the current AOS model, including delayed referrals and missed opportunities for admission avoidance, are clearly outlined, signalling an urgent need for service redesign to better align with national priorities and improve outcomes for cancer patients.

Next Steps and Recommendations:

1. UKAOS to disseminate the project and findings using the website, social media, learning hour, conference, and other platforms.

2. The UKAOS Nursing Group will define options and opportunities to improve Acute Oncology education for Emergency Departments (ED), including awareness of protocols and helplines.

3. The UKAOS Operational Steering Group will seek views and alignment with ED policy via the Royal College of Emergency Medicine (RCEM) and Emergency Medicine Nursing.

4. The UKAOS Data Group will further investigate ED cancer activity versus perceived Acute Oncology activity.

5. The UKAOS Nursing Group will identify and share any successful AOS in-reach models currently in existence.

6. The UKAOS Nursing Group will identify and share options for AOS ED alerts.

7. The UKAOS Nursing Group will identify and scope one AO/ED optimal pathway, linking existing service improvement to Neutropenic Sepsis (NS), Malignancy of Unknown Origin (MUO), and Metastatic Spinal Cord Compression (MSCC) workstreams.

8. The UKAOS SDEC and Hotline Groups will maintain a focus and priority on building Urgent Community Response (UCR) and Same Day Emergency Care (SDEC) capacity and pathways for cancer.

UKAOS wishes to thank Jo Davies for leading this work.