Evaluating the Impact of a Novel Referral Pathway for Suspected Cancer Cases in Emergency Department Patients

The emergency department (ED) is crucial for identifying acute cancer diagnoses, but the management and outcomes of post-ED cancer care remain unclear due to the absence of standardized protocols.

We assess the efficacy and outcomes of a newly introduced referral pathway, specifically tailored for ED patients whose ED evaluation is concerning for undiagnosed cancer.

A retrospective observational study was conducted at a single center, involving 161 patients evaluated in our ED. These patients were referred to our institution's Oncology Department through an ambulatory e-referral placed at the time of their ED discharge. The referral pathway, established in 2021, facilitated virtual coordination of care by an oncologist for ED patients suspected of having cancer.

Out of the 161 patients referred to the cancer pathway, 84 (52.2%) were subsequently diagnosed with biopsy or surgically confirmed cancer. All patients received evaluation by an oncologist within 1 business day. Among the diagnosed cases, 60 (75.0%) had available cancer staging information, with a majority presenting at advanced stages, including stage III (n = 12, 20.0%) or stage IV (n = 39, 65.0%). No patients died within 30 days of follow-up. The prevalent cancer types identified included lung (n = 26, 31.0%), renal cell carcinoma (n = 17, 20.2%), pancreatic (n = 6, 7.1%), head and neck (n = 6, 7.1%), and prostate (n = 6, 7.1%).

This study demonstrates the capacity of emergency physicians to recognize potential cases of undiagnosed cancer among ED patients. Utilizing an innovative care coordination pathway, these patients can be safely discharged with reliable follow-up mechanisms in place. Future endeavors should prioritize assessing the impact of this referral pathway on critical metrics such as time to biopsy, time to treatment initiation, and overall mortality rates.