Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study

• Published in: JNCI cancer spectrum 2024-04, Vol.8 (3)
• Main Authors: Thompson, Caroline A, Sheridan, Paige, Metwally, Eman, Peacock Hinton, Sharon, Mullins, Megan A, Dillon, Ellis C, Thompson, Matthew, Pettit, Nicholas, Kurian, Allison W, Pruitt, Sandi L, Lyratzopoulos, Georgios
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Black or African American - statistics & numerical data; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - ethnology; Comorbidity; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - epidemiology; Male; Marital Status; Medicare - statistics & numerical data; Neoplasm Staging; Neoplasms - diagnosis; Neoplasms - epidemiology; Poverty - statistics & numerical data; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - ethnology; SEER Program; Sex Factors; United States - epidemiology
• ISSN: 2515-5091; 2515-5091
• DOI: 10.1093/jncics/pkae039

Background Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. Methods We analyzed Surveillance, Epidemiology, and End Results Program–Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have “ED involvement” in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. Results Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. Conclusions The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations.