Routes to diagnosis and survival in Danish patients with non–small cell lung cancer: the impact of emergency admission

Background Worldwide, lung cancer remains the leading cause of cancer-related death. Studies have shown that receiving a lung cancer diagnosis following an unplanned admission is associated with poor prognosis. The causal relationship between emergency presentation and survival remains uncertain.Methods We conducted a population-based retrospective study including a random sample of 1,000 Danish patients diagnosed with non-small cell lung cancer (NSCLC) between 2014 and 2016, identified through the Danish Lung Cancer Registry. Detailed data on route to diagnosis, stage, performance status, comorbidity, and survival were retrieved from electronic health records. Associations between route to diagnosis and survival were examined using logistic regression adjusted for relevant clinical covariates.Results Of 974 eligible patients, 234 (24%) were diagnosed following emergency admission. These patients were more likely to present with advanced stage (stage IV: 70% vs. 43%) and have poorer performance status. One- and five‑year survival were markedly lower in patients admitted acutely (32% and 8%) compared to non-emergency presenters (56% and 22%; p < 0.001). The adjusted odds ratio for 5-year survival following emergency admission was 0.47 (95% CI 0.28–0.81). After adjusting for disease stage, emergency admission was no longer independently associated with survival.Conclusion Approximately one in four Danish patients with NSCLC were diagnosed following emergency admission. This route was strongly associated with advanced stage and poor prognosis, suggesting that emergency admission reflects late-stage disease rather than being an independent prognostic factor. Efforts to reduce diagnosis following emergency admission should focus on early detection, improved symptom awareness, and optimized diagnostic pathways.