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Poor & Minority Patients Receive Cancer Diagnosis in the Emergency Room

Fuerst, Mark L.

doi: 10.1097/01.COT.0000612772.11826.b4
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SAN FRANCISCO—Up to half of minority patients and those from lower socioeconomic groups are likely to receive a cancer diagnosis in the emergency room, suggesting a lack of access to primary care and cancer screening.

Hospital emergency departments are intended to be the location of entry into the health care system for patients with acute problems, such as injuries and myocardial infarctions. In contrast, cancer should optimally be detected during periodic health examinations, either through screening procedures or by early detection from signs and symptoms that prompt a routine visit to a physician.

Cancer is typically diagnosed by an oncologist or a general practitioner. However, about 20-50 percent of global cancer diagnoses stem from an emergency room visit among several ethnic minority groups who are poorer than their white peers, according to a new study.

Some of these visits are due to emergent clinical symptoms of a cancer that was not yet identified. Others are “incidental” diagnoses in which a patient seeks help for one ailment and is also found to have cancer. And still other patients visit the emergency room because they have no usual source of care, explained lead author, Caroline A. Thompson, PhD, MPH, Assistant Professor of Epidemiology at San Diego State University. The third group highlights one source of the cancer disparities that affect underrepresented populations, she said.

Thompson presented the results of the study at the 12th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

“Emergency room detection of cancer provides a window to understanding disparities in receipt of cancer screening and preventive care, since the emergency department sees a disproportionately high number of uninsured, underinsured, lower-income, and minority patients,” said Thompson.

The researchers assessed the prevalence of emergency department cancer detection in the U.S. in a study of 415,395 Medicare beneficiaries who had been diagnosed with breast, colorectal, lung, or prostate cancer between 2004 and 2013. They looked for patients who had had at least one emergency department claim in the month before the date of cancer diagnosis, and defined these claims as “ED-mediated.”

Overall, the study found that 11 percent of cancer diagnoses were ED-mediated, including 5 percent for those with breast cancer, 13 percent for colorectal cancer, 15 percent for lung cancer, and 6 percent for prostate cancer. Patients who went to the emergency room were more likely to be unmarried, Hispanic, black, or in the lowest income quartile. They were three times more likely to have multiple comorbidities.

Understanding which patients are diagnosed via an emergency room visit is important, because it can help researchers assess whether public health campaigns and primary care services are working, she said. “Someone who has a ‘screenable’ cancer detected in the emergency department has probably not been screened recently, or ever,” said Thompson. These patients are more likely to be diagnosed with an advanced stage of cancer, and may be more difficult to treat, she added.

Overall, the study highlights the importance of making screening and prevention available to all, including all racial/ethnic groups and those with lower socioeconomic status. “Screening works, and a routine checkup might alert a primary care provider to subclinical or early-stage disease before it becomes an emergency,” Thompson said.

The issue of emergency room detection has broader economic implications. “Cancer care episodes that begin in the emergency department are likely to be more resource-intensive and more costly than episodes that start in the primary care setting,” said Thompson. “Reducing emergency presentation of cancer patients may improve patient outcomes and health care system efficiency.”

The study is limited by focusing on Medicare enrollees, she said, and the results cannot be generalized beyond the elderly. However, since Medicare recipients should have a source of primary care, she anticipates that the issue of emergency department detection would be more significant in the wider public.

Mark L. Fuerst is a contributing writer.

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