The First Signs of Cancer Are Hiding in the Emergency Department: The 90 Days Before Diagnosis

According to a recent study, many patients with cancer visit an emergency department in the 90 days before their diagnosis.

Published on November 4, 2024, in Canadian Medical Association Journal (CMAJ) , this study analyzed retrospective data on people diagnosed with cancer in Ontario, Canada, between 2014-2021, covering 651 thousand adults.

The study found that 35.3% of patients had visited an emergency department at least once in the 90 days before their cancer diagnosis, and 51.4% of these patients were admitted to hospital.

The Relationship Between Emergency Department Visits and Cancer Diagnosis: Risk Factors and Contributing Factors

Factors associated with a higher rate of emergency department attendance included older age, comorbidities, previous hospital or emergency department visits, living in rural areas, residing in northern Ontario, living in socioeconomically disadvantaged areas, and receiving a cancer diagnosis in 2020 or 2021.

Certain cancer types in particular significantly increase the rate of emergency department visits before diagnosis. For example, patients with neurological cancers (such as brain tumors) are approximately 39 times more likely than usual to visit an emergency department. This rate is 15 times higher for patients with pancreatic cancer and 10 times higher for those with liver or gallbladder cancer. The emergency department attendance rate is 7 times higher for cancers in the lung region and 6 times higher for stomach–esophageal cancer. This indicates that these cancers can present with more sudden and serious symptoms.

These data show that symptoms are more severe in some cancer types, prompting patients to seek emergency medical care.

Should the Emergency Department Be Our First Stop for a Cancer Diagnosis?

For many patients with cancer, the emergency department can be the first step in the diagnostic process. Large studies show that emergency department visits play an important role among the various routes to a cancer diagnosis. Studies estimate that, depending on cancer type, cancer is first suspected in the emergency department in 16% to 50% of diagnoses . However, encountering a suspicion of cancer in the emergency department can be a major source of stress for patients. Emergency department settings, particularly those lacking advanced diagnostic resources and disease follow-up, may make patients' diagnostic journeys more difficult.

The Effects of Diagnosis in the Emergency Department: Impact on Stage and Survival

Patients diagnosed with cancer in the emergency department may have more advanced disease at diagnosis and shorter survival. They may also be older, have more limited access to primary care, and have lower socioeconomic status. The study also shows that patients diagnosed in the emergency department generally live in rural areas and have an immigrant background. This can be interpreted as an indicator of inequalities in healthcare systems.

Increased Emergency Department Visits During COVID-19

Another finding was that patients diagnosed with cancer in 2020 and 2021, when the COVID-19 pandemic began, had higher rates of emergency department visits. Restrictions on outpatient services, canceled appointments, and delays in many investigations during the pandemic led patients to turn to emergency departments for cancer symptoms. This suggests that the emergency department became a “way out” for patients during the pandemic.

High Emergency Department Attendance Rates for Certain Cancers: Why Do Some Cancer Types Require More Emergency Department Visits?

Emergency department attendance rates are particularly high among patients with certain cancer types, including neurological, pancreatic, liver, gallbladder, lung, and stomach–esophageal cancers. For example, neurological cancers can present with acute neurological symptoms, such as weakness, confusion, or seizures, which may require urgent assessment. Cancers such as pancreatic or liver cancer, on the other hand, often have symptoms that develop insidiously and may be detected after an emergency department visit.

Conclusion: Can Emergency Departments Offer Better Diagnostic and Treatment Pathways for Patients with Cancer?

The findings show that a striking proportion of patients visit an emergency department before their cancer diagnosis. Older people, socioeconomically disadvantaged individuals, rural residents, people with certain cancer types, and patients diagnosed during the pandemic attend emergency departments more frequently. The high use of emergency departments during the cancer diagnostic process raises new questions about how these departments could be used more effectively to organize diagnosis and treatment and guide patients.