Many Canadians end up in the ER before being diagnosed with cancer: study

Many cancer patients in Canada seek emergency care before their diagnosis, with more than half being hospitalized after a visit to the emergency room, according to new research.

A study published in the Canadian Medical Association Journal (CMAJ) On Monday, it emerged that more than a third of cancer patients in Ontario had visited an emergency department in the three months prior to their cancer diagnosis.

“This study highlights how often patients with cancer use the emergency department during the diagnostic phase of their cancer journey,” said Dr. Keerat Grewal, co-author of the study and an emergency room physician at Mount Sinai Hospital in Toronto.

“Nearly one in three patients use the emergency department prior to their diagnosis and there are certain patient populations that are more likely to use the emergency department,” she told Global News in an interview.

The study included more than 650,000 patients who were first diagnosed with cancer in Ontario between 2014 and 2021.

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While the data was limited to Ontario, Grewal said it's a trend seen across Canada.

The CMAJ study found that among patients who visited the emergency room 90 days before a cancer diagnosis, 64 percent visited an emergency room once, 23 percent visited twice, and 13 percent made three or more visits. More than half also ended up in hospital.

Older patients, those who lived in rural or northern parts of Ontario, as well as patients diagnosed with brain, pancreatic, liver, gallbladder or chest cancers were more likely to go to the emergency room, the study found. research.

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Because the study was based on administrative data, it is not clear whether the diagnosis of cancer, which typically requires a biopsy test, was made in the emergency department, Grewal said.

“In the emergency department, we often cannot say with certainty that a patient has been diagnosed with cancer, but we often have strong suspicions based on blood tests or suspicious imaging,” she said.

Grewal said there are multiple reasons why a patient comes in and leaves the emergency department with a suspected cancer diagnosis.

For example, patients in the emergency room may show signs or symptoms of an undiagnosed cancer, such as coughing up blood, and then later be diagnosed with lung cancer.

Some patients may come in for something completely unrelated and then incidentally receive a suspected cancer diagnosis through scans.

In other cases, patients who have a suspected cancer diagnosis through another outpatient route, such as a walk-in clinic, primary care physician, or other specialist, may visit the ER to try to expedite their follow-up.

An emergency department is “not the best environment” to receive a suspected cancer diagnosis, but patients who do end up there should have appropriate access to services, Grewal said.

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She said emergency physicians often only see patients once and most emergency departments in Ontario are not equipped to follow up with patients and ensure they receive a biopsy.

In Ontario, there are several diagnostic assessment clinics for suspected cancers, but these are usually only available for certain types of cancer.

Grewal said access to a cancer diagnosis should be streamlined from primary care or the emergency department.

“There are currently no standardized pathways for a patient suspected of cancer.”

“I think the next step is to figure out how we can better provide care to these patients from the emergency department, since we see so many patients before their diagnosis,” she added.

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More research is also needed to determine why some patient populations are more likely to use the emergency room, Grewal said.

According to one estimate, there will be 247,100 new cases of cancer and 88,100 cancer deaths in Canada by 2024. CMAJ study published in May.

This year, lung cancer is expected to be the most commonly diagnosed cancer, followed by breast, prostate and colorectal cancer, data shows.

– with files from Global News' Katherine Ward

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