Emergency cancer diagnosis in Paris: A cross-sectional study using AP-HP data

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Emergency presentation is linked to poorer cancer outcomes globally.
• Evidence on emergency cancer diagnosis in France is limited.
• Understanding emergency presentation is crucial for improving cancer care pathways.

Purpose of the Study:

• To determine the frequency of emergency presentation for major cancers in France.
• To investigate the association between emergency presentation and survival.
• To identify risk factors for emergency cancer diagnosis.

Main Methods:

• Retrospective analysis of 25,845 cancer patients at Assistance Publique Hôpitaux de Paris (AP-HP) from January 2019 to June 2022.
• Categorization of patients into emergency and non-emergency presentation groups.
• Statistical analysis to assess survival differences and risk factors, adjusting for metastatic status.

Main Results:

• 15.3% of cancer diagnoses were emergency presentations, with higher rates for pancreatic (23%) and colon (20%) cancers.
• Emergency presenters had higher rates of metastatic disease, less surgery (except colon cancer), and increased 1-year mortality.
• Emergency presentation was strongly associated with worse survival (HR 2.67), independent of metastatic status.
• Increased age and specific cancer types (lung, pancreatic) were linked to higher emergency presentation risk.

Conclusions:

• Emergency presentation is a significant route to cancer diagnosis in the Paris region.
• Prompt presentation and diagnosis initiatives are needed to improve cancer survival.
• Routine datasets can identify patients presenting via emergency routes, facilitating targeted interventions.