Study highlights emergency department utilization among cancer patients in Ontario

About 1 in 3 patients diagnosed with cancer in Ontario visited an emergency department (ED) in the 90 days before diagnosis, found a new study published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.240952.

In a study that included more than 650 000 patients diagnosed with cancer between 2014 and 2021 in Ontario, 35% (229 683) had visited an ED in the 90 days before diagnosis. Among patients with ED visits before their cancer diagnosis, 64% had visited once, 23% had visited twice and 13% had 3 or more visits. More than half (51%) of patients with an ED visit before diagnosis were admitted to hospital.

"The emergency department is not an ideal environment to manage patients with a suspected cancer diagnosis," writes lead author Dr. Keerat Grewal, an emergency physician and clinician scientist at the Schwartz/Reisman Emergency Medicine Institute at Mount Sinai Hospital, Toronto, Ontario, and ICES, along with coauthors. "Emergency departments are routinely overcrowded and have limited privacy. Receiving a suspected cancer diagnosis in this setting has been described by patients as distressing."

Emergency departments typically provide acute and episodic care, and most are not equipped to provide ongoing care after a suspected cancer diagnosis, which is essential to confirm the diagnosis and ensure patients are seen by the appropriate specialists.

"Although some patients may require hospital admission because of symptoms or complications related to the cancer presentation, relying on admission to hospital to ensure or expedite testing and follow-up from the emergency department is costly and contributes to hospital crowding, especially if these can be done in the outpatient setting," the authors write.

Most ED visits were related to symptoms of the type of cancer diagnosed. Patients later diagnosed with colorectal cancer had ED visits related to bowel obstruction and abdominal pain, and those with gastroesophageal cancer had ED visits related to gastrointestinal bleeding, difficulty swallowing, and abdominal pain. Patients with brain cancers had high odds of visiting the ED before diagnosis for weakness, confusion, or seizures.

Several patient groups were more likely to use the ED prior to a cancer diagnosis, including older adults, people from rural or northern areas, those living in marginalized neighborhoods, people with multiple illnesses, and those diagnosed during the COVID-19 pandemic. Patients who had immigrated within the previous 5 years were less likely to use the ED before diagnosis.

Findings were consistent with those of earlier studies from the United Kingdom and the United States.

Researchers used administrative data from ICES. They call for further research into why these patient groups use EDs more often and emphasize the need to ensure equitable access to further cancer workup from the emergency setting during the diagnostic phase of cancer in order to improve patient care and outcomes.