Background
The emergency department’s (ED) primary function is to provide attention to patients with acute symptoms. While timely cancer diagnosis is critical, the ED may not be the ideal location for diagnosis.
Methods
The Evaluation of Cancer Outcomes (ECO) Study is an initiative that extends population-based cancer data collection to include clinical and treatment information. Data was manually and electronically collected from medical records, clinical notes and information systems for all new patients with cancer who presented to hospital for diagnosis or treatment. This study investigates the first complete year (2009) for those within 50km of Geelong (n=1,307). The only ED servicing Geelong was at Geelong Hospital. ED presentations for patients identified in the ECO study were extracted from an electronic audit of Barwon Health medical records enabling the number of presentations 6 months prior to cancer diagnosis to be assessed.
Results
One in five (n=273) newly diagnosed cancer patients present to ED at least once in the 6 months prior to cancer diagnosis.One in nine (n=147) were diagnosed as a result of their ED visit.Patients presenting to ED were older (70.5 + 0.9 yr vs 66.6 + 0.4 yr, p<0.01), more likely to be male (24% of males vs 17% of females, p<0.01), resided within disadvantaged areas (disadvantaged 26.1%, middle 23.7%, advantaged 18.4%, p = 0.02), had a more advanced stage of cancer and significantly shorter survival.
Conclusion
This study confirms prior findings that those presenting to ED often have poorer survival outcomes. The ECO Study collects comprehensive data on all newly diagnosed cancer patients presenting to hospital. Published literature often reports on cohorts whose first presentation is to the ED and the subsequent cancer diagnoses. The uniqueness of this study is in the inbuilt random control group: those that did not present to ED.