Survival of patients who had cancer diagnosed through an emergency hospital admission: A retrospective matched case-comparison study in Australia

Background

Individuals diagnosed with cancer via emergency admission are likely to have poor outcomes. This study aims to identify cancer diagnosed through an emergency hospital admission and examine predictors associated with mortality within 12-months.

Method

A population-based retrospective 1:1 propensity-matched case-comparison study of people who had an emergency versus a planned hospital admission with a principal diagnosis of cancer during 2013–2020 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Conditional logistic regression examined predictors of mortality at 12-months.

Results

There were 28,502 matched case-comparisons. Individuals who had an emergency admission were four times more likely to die within 12-months (Odds Ratio (OR) 3.93; 95 % confidence interval (CI) 3.75–4.13) compared to individuals who had a planned admission for cancer. Older individuals, diagnosed with lung (OR 1.89; 95 %CI 1.36–2.63) or digestive organ, excluding colorectal (OR1.78; 95 %CI 1.30–2.43) cancers, where the degree of spread was metastatic (OR 3.61; 95 %CI 2.62–4.50), who had a mental disorder diagnosis (OR 2.08; 95 %CI 1.89–2.30), lived in rural (OR 1.27; 95 %CI 1.17–1.37) or more disadvantaged neighbourhoods had a higher likelihood of death within 12-months following an unplanned admission compared to referent groups. Females (OR 0.87; 95 %CI 0.81–0.93) had an 13 % lower likelihood of mortality within 12-months compared to males.

Conclusions

While some emergency cancer admissions are not avoidable, the importance of preventive screening and promotion of help-seeking for early cancer symptoms should not be overlooked as mechanisms to reduce emergency admissions related to cancer and to improve cancer survival.