Abstract Background Cancer diagnosis originating in emergency departments (EDs), “emergency presentation” (EP), contributes to poorer cancer survival and reflects both aggressive disease and limited access to routine healthcare. This study characterized EPs for a range of cancers and subclassified by whether patients were hospitalized after the emergency encounter, with the hypothesis that, compared to those hospitalized, patients not requiring hospitalization more specifically represent barriers to timely and adequate care. Methods We analyzed SEER-Medicare data for patients aged 66+ years diagnosed with 14 cancer types (2008-2017; N = 614,885). We described EP overall and demographic and clinical characteristics across subgroups using linear regression and assessed differences in healthcare utilization before the EP classification window. Results In total, 234,606 (38%) patients were classified as EPs, with 187,439 (80%) hospitalized. EPs were more likely than non-EPs to have pre-diagnostic emergency care (40% (95% CI = 40%-40%) vs. 30% (29%-30%)) and less likely to have non-emergency care for potential cancer symptoms (61% (61%-61%)) vs. 67% (67%-67%)), with minimal variation between inpatient and outpatient EPs. Compared to inpatient EPs, outpatient EPs were more often 70 years old (24% (23%-24%) vs.19% (19%-19%)), non-metropolitan residents (25% (24%-25%) vs. 12% (12%-12%)), with localized cancer (25% (25-26%) vs. 17% (17-17%)). Conclusion(s) Over one-third of older adult U.S. cancer patients with these cancer types are diagnosed through EP, with most requiring hospitalization. Outpatient EPs are more common among patients in rural areas with less advanced cancers, suggesting they may be an informative indicator of avoidable barriers to care less influenced by underlying health status.
Soppe et al. (Sat,) studied this question.