Emergency Department Use Prior to Cancer Diagnosis and Mortality.

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• The emergency department (ED) is an understudied pathway for cancer diagnosis, with over one-third of patients in Ontario, Canada, utilizing ED services before diagnosis.
• Understanding the impact of ED use on cancer patient outcomes is crucial for improving care delivery.

Purpose of the Study:

• To investigate the association between emergency department (ED) visits within 90 days prior to cancer diagnosis and subsequent all-cause mortality.
• To analyze how this association varies based on hospitalization status following the ED visit.

Main Methods:

• A retrospective, population-based cohort study utilizing administrative health data from Ontario, Canada.
• Matched 1:1 analysis of adults diagnosed with cancer between 2014-2021, comparing those with and without prior ED use, using propensity score matching.
• Follow-up for mortality occurred for up to 7 years post-diagnosis, analyzed using Cox proportional hazards regression with time-interaction terms.

Main Results:

• Patients with prior ED use exhibited a significantly higher risk of mortality compared to those without, with hazard ratios decreasing over time but persisting for 7 years.
• The increased mortality risk was more pronounced for patients admitted to the hospital from the ED (HR at 7 years: 1.30) compared to those discharged (HR at 7 years: 1.03).
• Overall mortality was 49.7%, with 61.7% mortality in the prior ED use group versus 37.8% in the no prior ED use group.

Conclusions:

• Emergency department use prior to cancer diagnosis is associated with increased long-term mortality risk.
• Findings emphasize the necessity for integrated care systems that facilitate prompt cancer diagnosis and management for patients presenting to the ED.
• Improvements in early cancer detection and non-emergency care pathways are vital to reduce reliance on EDs for initial cancer diagnosis and care.