Cancer diagnosed in the Emergency Department of a Regional Health Service

Rogers, Mark; Matheson, Leigh; Garrard, Brooke; Mukaro, Violet; Riches, Sue; Sheridan, Michael; Ashley, David M.; Pitson, Graham

doi:10.1111/ajr.12280

Cited by 14 publications

(13 citation statements)

References 14 publications

(23 reference statements)

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“…Prior research suggests that privately insured patients with cancer are more likely to rely on outpatient providers for nonemergent cancer care needs . By comparison, patients with Medicaid and with lower incomes have more limited access to outpatient providers and have been shown to repeatedly visit Emergency Departments for nonemergent health care needs . The disproportionate reliance on emergency department care by low‐income patients is demonstrated in our study.…”

Section: Discussionmentioning

confidence: 54%

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective

et al. 2019

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Background Emergency departments are playing an increasing role in cancer management. Emergency department utilization by patients with head and neck cancer, however, is unknown. Methods The 2009‐2011 Nationwide Emergency Department Sample was queried for patients with a principle diagnosis of head and neck cancer. Descriptive analysis was performed to characterize patient and hospital characteristics, outcomes, and charges. Logistic regression identified predictors of admission and mortality. Results A total of 31 390 patients were seen in the emergency department with head and neck cancer: 72.8% were admitted, 0.5% died in the emergency department, and 5.0% died during admission. Patients with cancer of unknown primary site had the greatest odds of admission (odds ration [OR]: 2.83; P < 0.0001). Privately insured patients (OR: 1.78; P = 0.001), those from higher income zip codes (OR: 1.56; P = 0.008), and those with oropharyngeal cancer (OR: 2.02; P = 0.0003) had the greatest odds of death. Conclusion These findings have direct implications for preventing unnecessary and costly emergency department visits, improving hospital and physician preparedness, and improving patient outcomes.

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Section: Discussionmentioning

confidence: 54%

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective

et al. 2019

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“…Other U.S. studies, not focused on cervical cancer, have found the proportion of cancer patients beginning their diagnostic workup in the ED ranging from 5% in 1992 to 32% in 2016 [ 11 , 12 , 19 ]. International studies on all cancers have reported diagnoses in the ED ranging from 14% of cancer patients in 2013 to 20% in 2016 [ 20 , 21 ]. Cancer presentation in the ED has been associated with less favorable patient characteristics such as advanced-stage disease and comorbid conditions, consistent with our findings [ 7 , 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic presentation of cervical cancer in emergency departments in California

Maguire

Cooley

Morris

et al. 2021

Cancer Causes Control

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Purpose Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and many women are diagnosed at advanced stages. Little is known about the degree to which U.S. women may begin their diagnostic workup for cervical cancer in Emergency Departments (ED). We sought to quantify the proportion of women presenting symptomatically in the ED prior to their diagnosis with cervical cancer and to describe their characteristics and outcomes. Methods We identified women diagnosed from 2006 to 2017 with cervical cancer in the California Cancer Registry. We linked this cohort to statewide ED discharge records to determine ED use and symptoms present at the encounter. Multivariable logistic regression models examined associations with ED use and multivariable Cox proportional hazards regression models examined associations with survival. Results Of the more than 16,000 women with cervical cancer in the study cohort, 28% presented symptomatically in the ED prior to diagnosis. Those presenting symptomatically were more likely to have public (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.06–1.27) or no insurance (OR 4.81; CI 4.06–5.71) (vs. private), low socioeconomic status (SES) (OR 1.76; CI 1.52–2.04), late-stage disease (OR 5.29; CI 4.70–5.96), and had a 37% increased risk of death (CI 1.28–1.46). Conclusion Nearly a third of women with cervical cancer presented symptomatically, outside of a primary care setting, suggesting that many women, especially those with low SES, may not be benefiting from screening or healthcare following abnormal results.

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“…This delay in diagnosis may be correlated with a significant number of our patient population living in poverty, having inadequate insurance, and poor access to the recommended screening as suggested by the U.S. Preventive Services Task Force [2,10]. These barriers to healthcare prevent earlier diagnosis and treatment, and as a result, patients presenting at the ED at ARMC are more likely to have a substandard prognosis and survival rate [3,14]. In addition, Rogers et al found that half of their patient population was diagnosed with cancer in the ED and suggested that their patients had limited awareness and knowledge about accessing PCPs even though the patients had insurance [3].…”

Section: Discussionmentioning

confidence: 99%

“…These barriers to healthcare prevent earlier diagnosis and treatment, and as a result, patients presenting at the ED at ARMC are more likely to have a substandard prognosis and survival rate [3,14]. In addition, Rogers et al found that half of their patient population was diagnosed with cancer in the ED and suggested that their patients had limited awareness and knowledge about accessing PCPs even though the patients had insurance [3]. Multiple studies suggested that types of insurance matter to timely breast cancer diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, women who are below the age of 50 years or who do not have access to breast cancer screening mammography are a fallout risk. In addition, without access to a primary care provider and routine early screening, these women of low socioeconomic status or marginalized ethnicity may present with various stages of breast cancer at the time of diagnosis in the emergency department [3]. Several demographic factors are known to influence the stage of cancer at diagnosis and are linked to a worse prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Healthcare Access Disparities on Initial Diagnosis of Breast Cancer in the Emergency Department

Yee¹,

Mazumder²,

Dong³

et al. 2020

Cureus

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Breast cancer continues to be the second leading cause of cancer deaths in women in the United States. This is more noticeable in communities with pronounced healthcare disparities. The aim of this study was to investigate the different demographics that might play a role in the detection of breast cancer in a county hospital emergency department (ED). A retrospective study was conducted of female patients diagnosed with breast cancer over a five-year period (1/1/2015 to 12/31/2018). Patients with breast cancer as the primary or secondary diagnosis were identified. This study shows that 66 (73.3%) women diagnosed in the ED were Hispanic or African American. There was a significant delay (a median of 461 days) in the time between the diagnosis of suspected breast cancer in the ED to their follow-up visit with definitive diagnosis in a primary care clinic. These findings suggest that women with a suspected breast cancer diagnosis who are seen in a safety net hospital and have Medicaid funding may have significant delays before final diagnosis is made. Patient demographics could have an impact on the patients' access to screening and regular healthcare visits, hindering an early breast cancer diagnosis by a primary care provider.

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Cancer diagnosed in the Emergency Department of a Regional Health Service

Cited by 14 publications

References 14 publications

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective

Symptomatic presentation of cervical cancer in emergency departments in California

Impact of Healthcare Access Disparities on Initial Diagnosis of Breast Cancer in the Emergency Department

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