Many cancer patients in Canada seek emergency help before their diagnosis, with more than half being hospitalized following an ER visit, according to new research.
A study published in the Canadian Medical Association Journal (CMAJ) on Monday showed that more than a third of cancer patients in Ontario had visited an emergency department in the three months prior to their cancer diagnosis.
“This study highlights how frequently patients with cancer are using the emergency department during the diagnostic phase of their cancer journey,” said Dr. Keerat Grewal, study co-author and an emergency medicine physician at Mount Sinai Hospital in Toronto.
“It’s almost one in three patients who are using the emergency department prior to their diagnosis and there are certain patient populations who are more likely to use the emergency department,” she told Global News in an interview.
The study included more than 650,000 patients who were first diagnosed with cancer between 2014 and 2021 in Ontario.
Even though the data was limited to Ontario, Grewal said it’s a trend that’s being seen across Canada.
The CMAJ study showed that among the patients with emergency department visits 90 days before a cancer diagnosis, 64 per cent visited an ER once, 23 per cent visited twice and 13 per cent had three or more visits. More than half were also hospitalized.
Older patients, those who resided in rural or northern parts of Ontario as well as patients who were diagnosed with brain, pancreatic, liver, gallbladder or thoracic cancer were more likely to go to ER, the research found.
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Since the study was based on administrative data, it’s not clear if the cancer diagnosis, which typically requires a biopsy test, was made at the emergency department, Grewal said.
“In the emergency department, we often can’t say for certain that a patient has a cancer diagnosis, but we often have heavy suspicions based on either bloodwork or suspicious imaging,” she said.
Why are cancer patients going to ER before diagnosis?
Grewal said there are multiple reasons why a patient might come in and leave the emergency department with a suspected cancer diagnosis.
For instance, patients in the ER may show signs or symptoms of an undiagnosed cancer, such as coughing up of blood, and then are later diagnosed with suspected lung cancer.
Some patients might come in for something completely unrelated and then have an incidental pickup of a suspected cancer diagnosis through scans.
In other cases, patients who have a suspected cancer diagnosis made through some other outpatient routes, such as a walk-in clinic, family doctor or another specialist, might visit the ER to try and expedite their follow-up.
An emergency department is “not the best environment” to have a suspected cancer diagnosis, but patients who do end up there should have the right access to services, Grewal said.
She said emergency physicians often see patients only once and most emergency departments in Ontario aren’t equipped to follow up on patients and ensure that they get a biopsy.
In Ontario, there are several diagnostic assessment clinics for suspected cancers, but these are usually only available for certain types of cancers.
Grewal said that access to a cancer diagnosis needs to be streamlined from either primary care or the emergency department.
“There are no standardized pathways for a patient who has suspected cancer to be worked up reliably right now.”
“I think the next step is trying to find out how we can better offer care to these patients from the emergency department given that we’re seeing so many patients prior to their diagnosis, ” she added.
More research is also needed to determine why some patient populations are more likely to use the ER, Grewal said.
In Canada, it is estimated that there would be 247,100 new cancer cases and 88,100 cancer deaths in 2024, according to a CMAJ study that was published in May.
This year, lung cancer is projected to be the most diagnosed cancer, followed by breast, prostate and colorectal cancers, data showed.
— with files from Global News’ Katherine Ward
