Presentation and management of patients with suspected cancer in the emergency department.

INTRODUCTION

The emergency department (ED) is an understudied route to cancer diagnosis. It is unclear how patients present to the ED at the time of suspected cancer diagnosis, and how physicians manage them. The objective of this study was to describe patient presentations and physician management for patients with a new suspected cancer in the ED.

METHODS

This was a prospective study at a tertiary care ED over a 1 year period (Mar 2024-2025). Emergency physicians completed data collection form patients seen in the ED with suspected cancer. Charts were reviewed daily to identify missed patients and pertinent data were extracted. We described types of suspected cancers seen, patient presentation, disposition, and physician acceptability of the follow-up process for cancer workup.

RESULTS

Over the 1 year, 164 patients with suspected cancer diagnoses were seen in the ED, with the top suspected malignancies being gynecological (22.0%), head and neck (11.6%), breast (10.4%), and colorectal (6.7%).The majority of patients (90.2%) presented with symptoms suggestive of malignancy, and 46.3% came to the ED to expedite workup of an already suspected cancer. Approximately, half (52.4%) received a specialist consult in the ED, with 64.0% of those patients subsequently admitted. Among patients who received a consult in the ED, 62.8% were referred not because they were acutely unwell, but to expedite diagnostic workup or due to uncertainty about arranging appropriate follow-up. Physician acceptability of follow-up varied by cancer type.

CONCLUSION

Patients with suspected cancer diagnoses are commonly seen in the ED. Many patients receive specialist consultations primarily to expedite diagnostic workup, which may not represent the most efficient use of already strained ED resources. Improved access to reliable and acceptable follow-up from the ED for further workup of patients with suspected cancer, regardless of cancer type, is needed.