What Percentage of Cancer Diagnoses Are Made in the Emergency Department?

Minorities and people with lower incomes are more likely than white or more affluent people to be diagnosed with cancer following an emergency department (ED) visit, according to a study presented at the 12^th American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. The conference was held in San Francisco, California Sept. 20-23.

“While some diagnosis of cancer in the ED is inevitable­-because of aggressive and symptomatic tumors-we would not expect some groups to be more affected than others as was seen in our analysis,” said lead author Caroline A. Thompson, PhD, MPH, assistant professor of epidemiology at San Diego State University in California.

The research team examined more than 415,000 Medicare beneficiaries diagnosed with 1 of 4 types of cancer between 2004 and 2013: breast, prostate, colorectal, or lung cancer. The team then searched administrative data for mentions of an ED visit in the month prior to the cancer diagnoses.

Eleven percent of patients’ cancer diagnoses were “ED-mediated” but rates varied by cancer type: 15% and 13% of lung and colorectal cancer diagnoses followed an ED visit, compared to 5% and 6% for breast and prostate cancer, the team found.

“One possible explanation is symptom-related,” Thompson told CancerNetwork®. “Lung and colorectal cancers, even at early stages, can manifest ‘alarm’ symptoms and complications such as coughing up blood or blood in stool, which might cause a patient to visit the emergency room. Breast and prostate cancer symptoms are not commonly associated with such alarms.”

Patients who had visited EDs prior to their cancer diagnoses were more likely than others to be low-income, Hispanic, African American, unmarried, and to have multiple comorbidities. Cancer care initiated in EDs are more costly than cancers diagnosed in a physician’s or oncologist’s office and ED detection can lead to longer delays in initiating definitive care, she noted.

“Sadly, this is not surprising,” said Tomi Akinyemiju, PhD, MS, associate professor, Department of Population Health Sciences at the Duke University School of Medicine and the Duke Global Health Institute in Durham, North Carolina.

Diverse structural barriers yield poor access to care in poor and minority neighborhoods, even among people with health insurance, Akinyemiju said. These can include out-of-pocket costs and transportation challenges.

“Imagine you have to take two buses across town to get to a hospital for cancer screening in your area,” Akinyemiju said. “And do you have childcare? It can be very complicated. Symptoms tend to be ignored for a while until they become pronounced.”

The findings bolster the case for expanded cancer screening services, Thompson suggested.

“As our study focused on two cancers that are commonly screened (breast and colorectal), the findings may point to a failure of screening campaigns to reach some populations,” she explained.

The study was supported by the National Institute of Health and the National Center for Advancing Translational Sciences at the University of California San Diego.