Clinical characteristics and outcomes for patients with an initial emergency presentation of malignancy: A 15 month audit of patient level data

Outcomes for Emergency Presentations of Lung Cancer: A Scoping Review

BACKGROUND

Lung cancer is frequently detected during visits to the emergency department (ED). The ED is crucial for identifying likely cases of lung cancer and coordinating the subsequent care for these patients.

OBJECTIVES

This scoping review aims to explore the definitions of emergency presentations (EPs) of lung cancer, along with mortality rates, cancer stage, and treatments for patients diagnosed with lung cancer following an EP.

METHODS

We conducted a scoping review of the literature on EPs of lung cancer, identifying 27 relevant articles out of 1338 initially screened.

RESULTS

Most studies originated from the United Kingdom, collectively reporting over 270,000 EPs of lung cancer. The majority of included studies provided strong evidence. Key findings revealed higher mortality rates among patients diagnosed with lung cancer through emergency presentations, with a significant proportion presenting at advanced stages. Patients with EPs were less likely to undergo surgical removal or receive radiotherapy. Lastly, only 66.7% of the studies defined an EP, with great heterogeneity among EP definitions. Methodological differences precluded meta-analysis.

CONCLUSION

Despite methodological heterogeneity, our synthesis indicates that patients presenting acutely with undiagnosed lung cancer often present at advanced stages and experience high mortality rates. These findings underscore the need for further research to develop evidence-based interventions for improving outcomes among ED patients with suspected lung cancer.

First-Time Diagnosis After an Emergency Presentation in Children With Cancer

AIM

To determine the prevalence rate of cancer diagnoses by an emergency route, the related risk factors and whether the emergency diagnosis was associated with poorer outcome.

METHODS

Retrospective observational study with identification of patients diagnosed at the Pediatric Oncology Unit of "Sapienza" University between 2008 and 2018. The percentage of patients who received a first-time diagnosis after an emergency presentation was determined. Two-year survival and clinical factors, such as sex, age and histology, associated to emergency presentation were evaluated.

RESULTS

Of 207 patients (109 girls and 98 boys; median age, 120 months), with a first-time diagnosis of solid tumor, 5.8% were diagnosed during an emergency admission after a median latency time of 2.5 days. Cases with an emergency diagnosis were younger compared with those who were diagnosed electively (median age, 30 months vs 120 months, P < 0.005). Higher prevalence rate of emergency presentation was detected in patients with lymphoma compared with those with no lymphoma disease (28.6% vs 4.1%; P < 0.0001). All patients were managed to overcome their emergency presentation, 33.3% of these died later. No statistically significant difference for 2-year overall survival was found between patients with an emergency diagnosis and those with elective diagnosis (66.7% vs 81.0%; odds ratio, 2.1; confidence interval, 0.6-7.5; P = 0.22).

CONCLUSIONS

A minor but not negligible number of pediatric patients come to a first-time diagnosis of cancer as result of a life-threatening event; risk factors were younger age and lymphoma disease. The emergency event can be successfully treated, and it was not related to a poorer survival.

Twelve tips for teaching oncology to non-oncologists

Background: Teaching subspecialty care to trainees who are not pursuing that subspecialty poses many challenges. These challenges are amplified in the teaching of oncology to non-oncologists because there are more new therapies emerging in oncology than in any other discipline, and there are few oncologic issues managed by generalists without consultation. Concurrently, there is an increasing need for generalists to manage many aspects of care for patients with cancer.Aim: To provide 12 tips for oncologists to use to educate trainees on their oncology rotations.Method: The tips provided are based upon the available literature and the authors' own experience.Results: The 12 tips presented offer specific strategies for oncologists to enhance their teaching by selection of appropriate content and enhancing delivery. Focus is placed on aspects of oncology that trainees are likely to encounter as a generalist or non-cancer subspecialist. While oncology is used as the case study, these strategies are adaptable to any subspecialty area.Conclusion: Oncologists and other subspecialists can be core medical educators.

Emergencies in Hematology and Oncology

The development of medical emergencies related to the underlying disease or as a result of complications of therapy are common in patients with hematologic or solid tumors. These oncological emergencies can occur as an initial presentation or in a patient with an established diagnosis and are encountered in all medical care settings, ranging from primary care to the emergency department and various subspecialty environments. Therefore, it is critically important that all physicians have a working knowledge of the potential oncological emergencies that may present in their practice and how to provide the most effective care without delay. This article reviews the most common oncological emergencies and provides practical guidance for initial management of these patients.

Emergency Presentation and Short-Term Survival Among Patients With Colorectal Cancer Enrolled in the Government Health Plan of Puerto Rico

Objective:

In this study, we examine factors associated with the use of the emergency room (ER) as an entry point into the health-care system to initiate a cancer diagnosis among Puerto Rico’s Government Health Plan (GHP) patients and compare the 1-year survival of GHP patients that initiated cancer diagnosis in the emergency room (ER) presentation with those that initiated the diagnosis in a physician’s office.

Methods:

Data for patients with colorectal cancer (CRC) aged 50 to 64 years and diagnosed in 2012 were obtained from the Puerto Rico Central Cancer Registry and linked to the Puerto Rico Health Insurance Administration database (n = 190). Crude odds ratio, adjusted odds ratio, and their 95% confidence intervals were reported. We used the Kaplan-Meier method to generate survival curves. Multivariate Cox regression analysis was performed to evaluate the association between ER presentation and 1-year cause-specific survival.

Results:

We found that 37.37% of the study population had an ER presentation. Male patients had a higher occurrence of having an ER presentation (66.20%), while 76.06% of the patients with an ER presentation were diagnosed in late stage. Emergency room presentation was a highly predictive factor for cancer mortality in the year following the diagnosis. These patients had between 3.99 to 4.24 times higher mortality risk than non-ER presentation patients (P < .05).

Conclusion:

Late presentation for CRC diagnosis through an ER visit is a significant concern that influences negatively on the patient’s outcome. Efforts at increasing primary care visits and routine screening tests among GHP beneficiaries could improve survival.

Emergency presentations of head and neck cancer: a modern perspective

Background:

Head and neck cancer emergency presentations are uncommon but persistent. However, there is little published literature on this aspect of cancer and patient demographics. This study aimed to assess the incidence, patient profile, tumour site and stage of emergency cancer presentations in our region.

Method:

Retrospective review of regional cancer database over a five-year period.

Results:

Emergency presentations accounted for 7 per cent of all cases. There was no difference in patient age and risk factors between the emergency and non-emergency presentations. The emergency presentation group showed a greater proportion of female patients compared to the non-emergency presentation group (30 vs 15 per cent). In all emergency presentations, the cancer was at advanced stages. Oropharyngeal cancer was the commonest emergency presentation of cancer, but the third commonest in the non-emergency group.

Conclusion:

Emergency presentations are increasing annually. Female patients and oropharyngeal cancer showed greater representation compared to male patients and laryngeal cancer.

Emergency route diagnosis of mucoepidermoid carcinoma initially diagnosed as a temporomandibular disorder

Salivary gland malignancy (SGM) can affect both major and minor glands and manifests clinically with various presentations. The most common type of SGM is mucoepidermoid carcinoma (MEC), which has been previously reported to be associated with symptomatology associated with temporomandibular disorders (TMD). This case report describes a patient with an aggressive form of MEC of the parotid gland that was initially diagnosed as TMD. In addition, the patient's MEC was diagnosed emergently based on development of acute clinical symptomatology. To the best of our knowledge, emergency route diagnosis of MEC affecting the parotid gland has not been previously reported in the literature.