Epidemiology

Internal medicine

Pathology

Cancer registry

Surveillance, Epidemiology, and End Results

Prostate cancer

Marital status

Population

Colorectal cancer

Cancer

Psychiatry

Odds ratio

Lung cancer

Comorbidity

Emergency department

Breast cancer

Medical diagnosis

Medicine

Environmental health

Journal of Clinical Oncology

139 Background: It is estimated that 20-50% of breast, colon and lung cancers are diagnosed in an emergency department (ED) globally. Cancer diagnosis via the ED worsens short-term survival and reduces quality of care. Studies in Europe have shown that older and socioeconomically deprived patients are at a higher risk of ED diagnosis. However, no studies in the U.S. have reported patterns of cancer patients initially presenting to the ED. We identified and characterized older patients who are diagnosed with a malignant tumor following presentation to an ED using data from the Surveillance, Epidemiology and End Results Medicare linked database. Methods: We studied 415,395 Medicare beneficiaries with histologically confirmed first malignant invasive tumors of the breast, colon and rectum, lung and prostate between 2004 and 2013. Patients were excluded if they did not have continuous coverage in the year prior to diagnosis, had more than one primary tumor, or were diagnosed after death. ED-mediated diagnosis was defined as having at least one ED claim in the month before the date of cancer diagnosis. Covariate adjusted generalized linear models were used to estimate prevalence odds ratios for marital status, race, comorbidity, and income levels. Results: Overall, 42,186 (11%) of cancer diagnoses were ED-mediated (by site: breast: 5%, colorectal: 13%, lung: 15%, prostate: 6%). Patients presenting to the ED were more likely to be: unmarried (OR:1.32; 95% CI: 1.29-1.34), Hispanic (OR:1.47; 95% CI: 1.37-1.57) or Black (OR:1.41; 95% CI:1.37-1.45), have 3+ comorbidities (OR:3.08; 95% CI: 3.00-3.16), and in the lowest income quartile (OR:1.26; 95% CI:1.21-1.30). Conclusions: While some cancers diagnosed in the ED may indicate incidental findings, later stage symptomatic cancers not identified until they become an emergency may reflect the failure of public health campaigns and primary care services. Reducing emergency presentation of cancer patients may improve patient outcomes and healthcare system efficiency.

Emergency department-mediated cancer diagnosis among older adults in the United States.