Many people imagine that cancer is usually discovered during a routine health check, a screening test such as a mammogram or colonoscopy, or after discussing new symptoms with their family doctor.
Early detection gives doctors more time to investigate suspicious changes, confirm a diagnosis, and begin treatment before the disease becomes more advanced. However, this is not how cancer is found for everyone.
For many older adults, the first sign of cancer appears during a medical emergency that leads them to the emergency department. New research suggests that this pathway to diagnosis may have a major impact on survival.
The new study was led by researchers at the University of North Carolina (UNC) and published in the Journal of the National Cancer Institute. The findings show that more than one in four older Americans with cancer first learn they have the disease after visiting an emergency department.
These patients have a much lower chance of surviving the first year after diagnosis than people whose cancer is discovered through routine medical care.
To better understand this issue, the researchers examined medical records from almost 930,000 Medicare patients who were diagnosed with one of 16 common types of cancer between 2008 and 2017. This made the study one of the largest investigations ever conducted into how the place and circumstances of a cancer diagnosis may influence patient outcomes.
The researchers found that about 28% of patients received their diagnosis after an emergency department visit, a situation known as an emergency presentation.
These patients were then divided into two groups. Some were sick enough to be admitted directly to the hospital from the emergency department, while others were considered stable enough to return home and complete further testing as outpatients before beginning treatment.
The differences in survival were striking. One year after diagnosis, about 81% of people whose cancer was found through routine outpatient care were still alive.
Among patients admitted to the hospital from the emergency department, only 36% survived the first year. Patients who visited the emergency department but were later discharged for outpatient investigations had an intermediate survival rate, with about 60% still alive after one year.
Importantly, these differences remained even after the researchers adjusted for factors that normally influence survival. They considered each patient’s age, the stage of the cancer, other medical conditions, and overall frailty.
Even after accounting for these important factors, people diagnosed through an emergency presentation continued to have a significantly higher risk of dying during the first year.
Lead author Dr. Caroline Thompson, an associate professor of epidemiology at the UNC Gillings School of Global Public Health and a member of the UNC Lineberger Comprehensive Cancer Center, said the findings show that the way cancer is discovered provides valuable information beyond the cancer itself.
According to the researchers, the circumstances surrounding diagnosis may reflect delays in recognizing symptoms, difficulties accessing timely testing, or other barriers within the healthcare system.
One surprising finding involved patients who were sent home from the emergency department to complete additional testing. The researchers found that these individuals had used primary care services at similar rates to people whose cancers were diagnosed through routine outpatient care.
This suggests that many of them were not avoiding medical care. Instead, opportunities to identify cancer earlier may have been missed despite previous contact with healthcare providers.
The pattern was also seen in several cancers that are often considered more treatable or more likely to be detected through screening, including breast cancer, prostate cancer, bladder cancer, and certain blood cancers. This indicates that emergency diagnosis is not limited to only the most aggressive cancers.
The researchers believe these findings have important implications for doctors, hospitals, and healthcare systems.
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