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

Many cancer patients are diagnosed following an emergency hospital admission in the 30 days preceding their diagnosis ('emergency presentation') and these patients have worse outcomes. Despite multiple international studies, there is only sparse evidence on emergency diagnosis of cancer in France. We examined the frequency of emergency presentation and its association with survival in patients with breast, lung, colon, rectal and pancreatic cancer, using data from the Paris Region University Hospitals (Assistance Publique Hôpitaux de Paris, AP-HP). Between January 2019 and June 2022, 25,845 patients were newly referred with a relevant cancer, of whom 3960 (15.3%) were emergency presentations (23% for pancreatic, 20% for colon, 19% for lung, 9% for rectal and 6% for breast cancer). Emergency presenters were more likely to have metastatic cancer, less likely to have surgical treatment (except for colon cancer patients), and more likely to die within a year from diagnosis. The risk of emergency presentation increased with age and was higher for lung and pancreatic cancer. Emergency presentation rates for lung cancer were highest in the first Covid-19 pandemic year (2020). Emergency presentation was strongly associated with worse survival compared with non-emergency presentation (HR 2.67, 95% CI 2.52-2.84), even after adjustment for metastatic status. Emergency presentation is a common route to diagnosis in AP-HP and can be identified from routine datasets. Efforts to reduce diagnosis as an emergency may help improve cancer outcomes, justifying public health and health system initiatives supporting prompt presentation and diagnosis.