Novel referral pathway for patients with new solid tumors discharged from the emergency department: A pilot study

Abstract

Many patients with undiagnosed cancer have a preceding emergency department (ED) visit that has a workup concerning for cancer. 1 A diagnosis of cancer following an ED visit is associated with inferior patient-reported and clinical outcomes compared to patients that are diagnosed through routine screening. 1 Little prospective data exists describing the care for patients diagnosed with cancer from an ED visit. 1,2 Delays in time to treatment for new cancer diagnoses continue to increase, with absolute increased risk of mortality ranging from 1.2 to 3.2% per week in curative settings with various early-staged cancers. 3 Patients whose care was coordinated through their primary care physician experienced longer delays than patients who saw specialists directly, and in one analysis 29% of patients with lung cancer experienced a wait of 90 days or more. 4 Reasons for prolonged time to treatment are multifactorial, as delays can be experienced for tissue sampling, tumor board discussion, and staging. 5 It is currently unknown how the transitions of care from the ED impact these times.

A qualitative analysis of patients’ experiences with an emergency department diagnosis of gastrointestinal cancer

“…A pilot study on a fasttrack program in the United States has been explored, suggesting this method is feasible, but the impact of this type of program on patient outcomes has yet to be published. 33 While not the main objective of our study, these issues highlight that even when patients present to the ED as the result of appropriate escalation and speed, the process of receiving a diagnosis is often traumatic. Previously published qualitative studies suggest patients choose the ED when they believe that they are no longer able to wait to seek medical assistance.…”

“…Thus, a fast‐track program in the United States is an attractive solution to expedite diagnostic testing in cases where cancer is suspected. A pilot study on a fast‐track program in the United States has been explored, suggesting this method is feasible, but the impact of this type of program on patient outcomes has yet to be published 33 …”