Diagnosis of lung cancer following emergency admission: Examining care pathways, clinical outcomes, and advanced NSCLC treatment in an Italian cancer Center
Giacomo Vallome,
Iacopo Cafaro,
Annarita Bottini,
Chiara Dellepiane,
Giovanni Rossi,
Elisa Bennicelli,
Francesca Parisi,
Lodovica Zullo,
Marco Tagliamento,
Alberto Ballestrero,
Emanuela Barisione,
Ines Maria Grazia Piroddi,
Fabrizio Montecucco,
Federico Carbone,
Paolo Pronzato,
Matteo Lambertini,
Francesco Spagnolo,
Giulia Barletta,
Lucrezia Barcellini,
Michele Ferrante,
Simone Nardin,
Simona Coco,
Silvia Marconi,
Linda Zinoli,
Paolo Moscatelli,
Eleonora Arboscello,
Lucia Del Mastro,
Andrea Bellodi,
Carlo Genova
Affiliations
Giacomo Vallome
U.O. Oncologia Medica, Ospedale Padre Antero Micone, ASL3, Genoa, Italy
Iacopo Cafaro
U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Annarita Bottini
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
Alberto Ballestrero
U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
Emanuela Barisione
U.O. Pneumologia a Indirizzo Interventistico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Ines Maria Grazia Piroddi
U.O. Pneumologia a Indirizzo Interventistico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Fabrizio Montecucco
First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italian Cardiovascular Network, Genoa, Italy
Federico Carbone
First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italian Cardiovascular Network, Genoa, Italy
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Francesco Spagnolo
U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genoa, Italy
UO Tumori Polmonari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Silvia Marconi
UO Tumori Polmonari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Linda Zinoli
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Paolo Moscatelli
UO Medicina Interna, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Eleonora Arboscello
Dipartimento di Emergenza Urgenza e Accettazione (DEA), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Lucia Del Mastro
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Andrea Bellodi
U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Carlo Genova
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Corresponding author. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.
Background: Lung cancer patients diagnosed following emergency admission often present with advanced disease and poor performance status, leading to suboptimal treatment options and outcomes. This study aimed to investigate the clinical and molecular characteristics, treatment initiation, and survival outcomes of these patients. Methods: We retrospectively analyzed data from 124 patients diagnosed with lung cancer following emergency admission at a single institution. Clinical characteristics, results of molecular analyses for therapeutic purpose, systemic treatment initiation, and survival outcomes were assessed. Correlations between patients’ characteristics and treatment initiation were analyzed. Results: Median age at admission was 73 years, and 79.0 % had at least one comorbidity. Most patients (87.1 %) were admitted due to cancer-related symptoms. Molecular analyses were performed in 89.5 % of advanced non-small cell lung cancer (NSCLC) cases. In this subgroup, two-thirds (66.2 %) received first-line therapy. Median overall survival (OS) was 3.9 months for the entire cohort, and 2.9 months for patients with metastatic lung cancer. Among patients with advanced NSCLC, OS was significantly longer for those with actionable oncogenic drivers and those who received first-line therapy. Improvement of performance status during hospitalization resulted in increased probability of receiving first-line systemic therapy. Discussion: Patients diagnosed with lung cancer following emergency admission demonstrated poor survival outcomes. Treatment initiation, particularly for patients with actionable oncogenic drivers, was associated with longer OS. These findings highlight the need for proactive medical approaches, including improving access to molecular diagnostics and targeted treatments, to optimize outcomes in this patient population.
