Emergency cancer diagnosis in older adults: patterns, subgroups, and implications for health-care quality metrics
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Cancer diagnosis originating in emergency departments (emergency presentation) contributes to poorer cancer survival and reflects aggressive disease and limited access to routine health care. This study characterized emergency presentations for a range of cancers and subclassified by whether patients were hospitalized after the emergency encounter, with the hypothesis that, compared with those hospitalized, patients not requiring hospitalization more specifically represent barriers to timely and adequate care. METHODS: We analyzed Surveillance, Epidemiology, and End Results-Medicare data for patients aged 66 years and older diagnosed with 14 cancer types (2008-2017; n = 614 885). We described emergency presentation overall and demographic and clinical characteristics across subgroups using linear regression and assessed differences in health-care utilization before the emergency presentation classification window. RESULTS: In total, 234 606 (38%) patients were classified as emergency presentations, with 187 439 (80%) hospitalized. Emergency presentations were more likely than nonemergency presentations to have prediagnostic emergency care (40%, 95% confidence interval [CI] = 40% to 40%) vs 30% (95% CI = 29% to 30%) and less likely to have nonemergency care for potential cancer symptoms (61%, 95% CI = 61% to 61%, vs 67%, 95% CI = 67% to 67%), with minimal variation between inpatient and outpatient emergency presentations. Compared with inpatient emergency presentations, outpatient emergency presentations were more often younger than 70 years old (24%, 95% CI = 23% to 24%, vs 19%, 95% CI = 19% to 19%), nonmetropolitan residents (25%, 95% CI = 24% to 25%, vs 12%, 95% CI = 12% to 12%), and had localized cancer (25%, 95% CI = 25% to 26%, vs 17%, 95% CI = 17% to 17%). CONCLUSIONS: More than one-third of older adult US cancer patients with these cancer types are diagnosed through emergency presentation, with most requiring hospitalization. Outpatient emergency presentations are more common among patients in rural areas with less advanced cancers, suggesting they may be an informative indicator of avoidable barriers to care less influenced by underlying health status.
Source: JNCI Cancer Spectrum
Institutions: University of North Carolina at Chapel Hill, University of Connecticut, UConn Health, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, University College London, Stanford Medicine, Stanford University, Indiana University Indianapolis, Indiana University School of Medicine, University of Washington, UNC Lineberger Comprehensive Cancer Center
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,050
Funders: V Foundation for Cancer Research, California Department of Public Health, RSNA Research and Education Foundation, University of Southern California, Leona M. and Harry B. Helmsley Charitable Trust, Takeda Science Foundation, Japan Agency for Medical Research and Development, American Lebanese Syrian Associated Charities, Joint Programming Initiative A healthy diet for a healthy life, PETRONAS, Ho Chi Minh City University of Technology and Education, Ministerul Cercetării, Inovării şi Digitalizării, Economic Development Board - Singapore, National Natural Science Foundation of China, Grantová Agentura České Republiky, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, King Saud University, Imam Mohammed Ibn Saud Islamic University, China Postdoctoral Science Foundation, Ministry of Higher Education, Malaysia, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Huaqiao University, Karolinska Institutet, Javna Agencija za Raziskovalno Dejavnost RS, Natural Science Foundation of Shanxi Province, Natural Science Foundation of Jiangsu Province, University of Science Ho Chi Minh City, National Chung-Hsing University, Fundação de Amparo à Pesquisa do Estado de Goiás, Hokkaido University, Universitas Indonesia, King Khalid University, Fundación Charles Darwin, Zhejiang University of Technology, Tarim University, Xiamen University, Jiangsu Science and Technology Department, Nagoya City University, University of Science and Technology of China, Instituto Nacional de Ciência e Tecnologia de Catálise em Sistemas Moleculares e Nanoestruturados, Anhui Provincial Department of Science and Technology, State Key Laboratory of Chemical Resource Engineering, Shanghai Rising-Star Program, Vision Group on Science and Technology, Ministerul Cercetării şi Inovării, Galapagos Conservation Trust, Indian Institute of Technology (BHU) Varanasi, Essity Germany, National Institutes of Health, Centers for Disease Control and Prevention, University of California, San Francisco, Sichuan Province Science and Technology Support Program, Natural Sciences and Engineering Research Council of Canada, Biotechnology and Biological Sciences Research Council, Japan Society for the Promotion of Science, Japan Science and Technology Agency, Natural Science Foundation of Anhui Province, Key Technologies Research and Development Program, National Key Research and Development Program of China, Dalin Tzu Chi Hospital, Zayed Bin Sultan Center for Health Sciences, United Arab Emirates University, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Cancer Institute, National Institute of Nursing Research, National Center for Special Education Research, Institute of Education Sciences, Science and Technology Department of Zhejiang Province, NextGenerationEU, Key Research and Development Program of Zhejiang Province
Awards: G1352184354, G1395202410, G2337224928, G2612351997, G3448447748, G3467199957, G3509688676, G4332884407, G4854421162, G504639888, G5631299761, G671936517, G6951404960, G7290139498, G8083727551, G8380263711, G8509442309, G9000055636, Diagnosis of Cancer in the Emergency Room - Explaining Persistent Disparities, G946791773
OpenAlex ID: W7126017774