Management of gynecological cancers in the emergency department: Impact of precariousness and prognostic factors

Sophia Najid; Grégoire Miailhe; Camille Mimoun; Bassam Haddad; Edouard Lecarpentier; Yohann Dabi

doi:10.1016/j.jogoh.2023.102686

Management of gynecological cancers in the emergency department: Impact of precariousness and prognostic factors

J Gynecol Obstet Hum Reprod. 2023 Dec;52(10):102686. doi: 10.1016/j.jogoh.2023.102686. Epub 2023 Oct 24.

Authors

Sophia Najid¹, Grégoire Miailhe², Camille Mimoun³, Bassam Haddad⁴, Edouard Lecarpentier⁴, Yohann Dabi⁵

Affiliations

¹ Obstetrics and Gynaecology Department, Centre Hospitalier Intercommunal de Creteil, Créteil, France.
² Department of Surgery, Institut Curie, Saint-Cloud, France.
³ Obstetrics and Gynaecology Department, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris France.
⁴ University Paris-Est Créteil - Department of Obstétrics, Gynaecology and Reproductive Medicine, Centre Hospitalier Intercommunal de Creteil, Créteil, France.
⁵ Sorbonne University - Department of Gynecology Obstetrics and Reproductive medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris France. Electronic address: yohann.dabi@gmail.com.

PMID: 37884225
DOI: 10.1016/j.jogoh.2023.102686

Abstract

Objective: The primary objective was to determine the profile of patients consulting in an emergency department and diagnosed with a pelvic cancer. Our secondary objective was to assess the potential impact on this diagnostic trajectory on survival.

Method: A single-center retrospective study including patients managed for a pelvic cancer between January 2018 and November 2020 in the center Hospitalier Intercommunal de Creteil was conducted. Patients' characteristics were compared based on their diagnostic trajectory (emergency or referred to consultation). Precariousness was assessed using Pascal's tool based on 4 characteristics: being a beneficiary of the former Couverture Maladie Universelle (CMU) or Aide Medicale d'Etat (AME), not having complementary health insurance, being job seeking for more than 6 months and being beneficiary of allowances. A patient was defined as precarious if the Pascal tool was 'TRUE', i.e., at least one positive item. The main socio-demographic and cancer associated factors were analyzed as prognostic factors.

Results: Over the inclusion period, among the 283 eligible patients, 37.3 % (87/233) had a diagnosis of cancer following an emergency department visit. There was a significant association between precariousness, rupture of gynecological follow-up, lack of participation in national screening campaigns and the risk of being diagnosed through the emergency pathway for all cancers studied (p = 0.001). There was no difference in terms of stage at diagnostic, management (according to current guidelines), prognostic and overall survival between the two groups.

Conclusion: Patients in a situation of precariousness are more likely to be diagnosed with cancer in an emergency department. Our study underlines the importance of precariousness as a factor determining the type of diagnostic management of gynecological cancer. Efforts should be made toward improving frail patients to primary care.

Keywords: MeSH: Pelvic cancers; Precariousness; Prevention; Primary health care; Social vulnerability.

MeSH terms

Emergency Service, Hospital
Humans
Insurance, Health
Pelvic Neoplasms*
Prognosis
Retrospective Studies