Cancer diagnosed in the Emergency Department of a Regional Health Service

Abstract

Objective: Patients diagnosed with cancer in the Emergency Department (ED) have more advanced disease at diagnosis and poorer outcomes. High rates of initial presentation to ED suggest potential problems with access to care. The aim of this project was to interpret findings in regional/rural Victoria and explore implications for practice.

Design: Cross-sectional study linking two independent data sets.

Setting: Regional city of Geelong and surrounding rural areas in south-west Victoria.

Participants: All newly diagnosed cancer patients in 2009.

Main outcome measures: Number of cancer patients diagnosed in the ED.

Results: One in five newly diagnosed cancer patients present to ED 6 months prior to cancer diagnosis. One in 10 is diagnosed as a result of their ED visit. Patients presenting to ED were older, more often men and from disadvantaged areas. Symptoms on presentation included chest complaints, bowel obstruction, abdominal pain, anaemia and generalised weakness. Cancer diagnosed in the ED is associated with advanced stage and shorter survival.

Conclusion: Reasons for presentation to ED would be multifactorial and include complex cases with coexisting symptoms making diagnosis difficult. The general public appear to have a low level of awareness of alternative primary care services or difficulty accessing such information. Some of the changes towards reducing the number of patients presenting to ED will include patient education.

Keywords: Emergency Department; cancer; diagnosis; socio-economically disadvantaged; symptoms.