The following is a summary of “Retrospective review of patients with lung cancer presenting emergently,” published in the September 2023 issue of Emergency Medicine by Pettit, et al.
Many lung cancer patients are diagnosed during emergency presentations (EPs) to emergency departments (EDs). For a study, researchers sought to provide an overview of EPs related to lung cancer at a safety-net hospital system.
A retrospective analysis was conducted on patients with lung cancer who visited a safety-net ED. EPs were defined as patients diagnosed with lung cancer due to acute presentations with symptoms of undiagnosed lung cancer (e.g., cough, hemoptysis, shortness of breath). Non-EPs were diagnosed incidentally (e.g., trauma pan-scan) or as part of lung cancer screening.
The study reviewed 333 patient charts with lung cancer. Among these, 248 (74.5%) were categorized as EPs. EP patients were more likely to have stage IV cancer than non-EP patients (50.4% vs. 32.9%). The percentage of mortality was higher for EPs compared to non-EPs (60.0% vs. 49.4%), mainly due to the high mortality rate for stage IV EPs (77.5%). Most EP patients had their initial visit in the ED (71.4%) with a workup indicating lung cancer. Most EPs were admitted to complete diagnostic workups or for symptom management (66.5%). Logistic regression revealed significant predictors for EPs, including stage IV at diagnosis (OR 2.49, 95% CI 1.39–4.48) and the absence of primary care (OR 0.07, 95% CI 0.009–0.53).
In a safety-net healthcare setting, most lung cancer patients have an acute presentation as an EP with advanced stage. The ED played a crucial role in the initial diagnosis of lung cancer and the coordination of subsequent cancer care.