Emergency department associated lung cancer diagnosis: Case series demonstrating poor outcomes and opportunities to improve cancer care

Abstract

The diagnosis of cancer through an emergency presentation of an undiagnosed malignancy constitutes around 20–50% of first-time cancer diagnoses. There is a paucity of evidence on the emergency presentations of undiagnosed malignancy with only a few epidemiological studies of large administrative databases. Limited administrative data has shown patients diagnosed with cancer after an emergency presentation suffer poorer clinical outcomes as compared to those diagnosed with cancer through elective routes. Further those diagnosed emergently are commonly among vulnerable populations, such as based on socioeconomic status and racial/ethnic groups. Lung cancer is the most common cancer diagnosed emergently, and while one of the most preventable and treatable, often presents to an emergency department in extremis. This case study of six patients seeks to augment administrative database research by adding detailed clinical information as to demonstrate the issues with diagnosing lung cancer through an emergency presentation. We found that patients diagnosed emergently have complex care pathways including delayed biopsies, delayed treatments, and poor outcomes. Research is needed to elucidate the optimal path on how to manage suspected lung cancer diagnoses from the emergency department.