Emergency admission preceding malignancy diagnosis: Insights from a study at a tertiary care hospital

Abstract

BACKGROUND: A considerable number of cancer patients are diagnosed following presentation at emergency department with symptoms related to their condition, yet research in this area remains scarce. This study aimed to identify the clinical characteristics and evaluate the health outcomes of patients who presented to the emergency department with symptoms of cancer. MATERIALS AND METHODS: We analyzed data for patients diagnosed with cancer postemergency department presentation at a tertiary care hospital between 2015 to 2021. Data on patient characteristics, clinical features, and health outcomes was abstracted through meticulous review of the patients’ medical record. SPPS was used for data analysis. Wilcoxon rank-sum test and Chi-square or Fisher’s exact test as appropriate, were used to determine statistical significance for continuous and categorical variables, respectively. Regression analysis determined factors associated with treatment and mortality. Kaplein-Meier analysis was performed to determine survival time. RESULTS: During the study period, 108 patients were diagnosed with new malignancies following acute medical admission. The median age of these patients was 67 years (interquartile range [IQR]: 56–75), and 58 (53.7%) of these patients were men. The most common presenting complaints were pain (55.6%), weight loss (44.4%), and poor appetite (36.1%). The median time from the onset of symptoms to hospital presentation was 30 days (IQR 8–62). The most common types of malignancies diagnosed in the study were hepatobiliary (18.5%), gastroesophageal (15.7%), and lung cancer (14.8%). Two-thirds of patients had Stage IV malignancy, and 64.81% presented with distant metastatic disease at the time of diagnosis. Older age (69 vs. 61.5 years; P = 0.04), lower level of general education and higher attainment (11.4% vs. 44.4%; P < 0.01), advanced malignancy stages (P < 0.01), and metastatic disease at diagnosis (75.4% vs. 44.4%; P = 0.01) were associated with higher mortality. CONCLUSION: Emergency presentations for newly diagnosed cancer, often seen in older patients with lower education and multiple comorbidities, were generally associated with poor survival rates owing to advanced disease with distant metastasis. Enhancing awareness of critical symptoms could improve early detection rates.

Keywords

• comorbidity
• emergency service
• malignancies
• metastatic disease
• mortality
• neoplasms
• survival rate