Conley Hannah L, Lea C Suzanne, Delgado Raven V, Vos Paul, Harris Eleanor E, Ju Andrew, Rathbun Kimberly M
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
Department of Public Health, Brody School of Medicine, Greenville, NC, USA.
J Racial Ethn Health Disparities. 2023 Oct;10(5):2434-2443. doi: 10.1007/s40615-022-01422-3. Epub 2022 Oct 10.
Patients whose cancer was found during an Emergency Department (ED) visit often present at later stages when survival outcomes are worse. Limited research has characterized the survival experience of cancer patients who receive their diagnosis through the ED versus those who do not.
A retrospective cohort study identified all patients presenting to the ED between 2014 and 2015 in a rural, regional hospital system with a visit or resulting admission associated with an oncologic ICD-9 code. The chart was abstracted to determine a new cancer diagnosis versus an existing case. Cox proportional hazards (HR) estimated survival time. Patient and cancer characteristics were compared between those who were newly diagnosed through the ED and patients who were not.
Thirty-nine percent of patients in our sample received their new cancer diagnosis as a result of an ED visit. The median survival was lower in cancer cases diagnosed through the ED (13 vs. 39 months, P < .001), men (20 vs. 32 months, P < .001), and patients aged ≥ 65 (22 months vs. 32 months, P < .001). Factors associated with lower survival were having a type of cancer location other than breast (HR = 1.96; P < .001), followed by being newly diagnosed with cancer through the ED (HR = 1.71; P < .001), and stage IV at diagnosis (HR = 1.70; P < .001).
Patients who received a new cancer diagnosis through the ED and required subsequent hospitalization had shorter overall survival and presented with advanced disease. Future research should address socioeconomic factors that may influence these patterns of cancer presentation.
在急诊科就诊期间被发现患有癌症的患者，往往在生存结局较差的晚期才出现。关于通过急诊科确诊癌症的患者与未通过急诊科确诊癌症的患者的生存经历，相关研究有限。
一项回顾性队列研究确定了2014年至2015年期间在一家农村地区医院系统急诊科就诊的所有患者，这些患者的就诊或随后的住院与肿瘤ICD-9编码相关。查阅病历以确定新的癌症诊断与现有病例。采用Cox比例风险模型（HR）估计生存时间。比较通过急诊科新确诊的患者与未通过急诊科确诊的患者的患者和癌症特征。
在我们的样本中，39%的患者因急诊科就诊而被新确诊为癌症。通过急诊科确诊的癌症病例的中位生存期较低（13个月对39个月，P < 0.001），男性患者（20个月对32个月，P < 0.001），以及年龄≥65岁的患者（22个月对32个月，P < 0.001）。与较低生存率相关的因素包括癌症部位不是乳房（HR = 1.96；P < 0.001），其次是通过急诊科新确诊为癌症（HR = 1.71；P < 0.001），以及诊断时为IV期（HR = 1.70；P < 0.001）。
通过急诊科新确诊癌症并需要随后住院治疗的患者总生存期较短，且疾病处于晚期。未来的研究应探讨可能影响这些癌症表现模式的社会经济因素。
