Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Emergency Presentation Prior to Cancer Diagnosis in Victoria: Identifying Variation in Diagnostic Pathways Across Culturally and Linguistically Diverse Populations (144482)

Frances F Graham 1 , Helena Rodi 1 , Phillip Parente 2 , Beverley Woon 3 , Ella Stuart 4 , Tommy Wong 4 , Linda Nolte 1
  1. North Eastern Melbourne Integrated Cancer Service, Heidelberg, Melbourne, Victoria, Australia
  2. Director of Cancer Services, Medical Oncologist, Monash University; Eastern Health, Melbourne, Victoria, Australia
  3. Sir Peter MacCallum Department of Oncology, University of Melbourne; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. Cancer and Specialist Therapies | Aged Care and Systems Priorities Branch, Victorian Department of Health; Cancer Council Victoria, Melbourne, Victoria, Australia

Background

Emergency department (ED) presentation shortly before a cancer diagnosis is increasingly recognised as a marker of fragmented and inequitable diagnostic pathways and is associated with poorer outcomes. However, evidence describing variation in emergency diagnostic pathways across tumour streams and priority populations remains limited.

Aim

To identify and quantify unwarranted variations in ED presentation within 28 days prior to cancer diagnosis (steps 2 and 3 of the Optimal Care Pathway framework) across four tumour streams and Victorian Culturally and Linguistically Diverse (CALD) population groups.

Methods

A population-based retrospective cohort study was undertaken using linked Victorian administrative datasets, including the Victorian Cancer registry and Victorian Emergency Minimum Dataset. Analyses incorporated patients diagnosed with breast, colorectal, lung and prostate cancer between 2019 and 2023 (n = 80,813). ED presentations occurring within 28 days prior to diagnosis were examined by tumour stream and country of birth. Rates among patients born in English speaking countries were compared with those observed in CALD populations.

Results

Overall, 15% of patients from English-speaking countries experienced ED presentation within 28 days prior to diagnosis. Significantly higher rates were observed among patients born in Arabic-speaking countries (20%), South-Eastern Europe (25%), Southern Europe (21%) and Vietnam (19%). Variation was also evident by tumour type. Elevated ED presentation rates were observed among patients from Arabic-speaking countries across breast, colorectal and lung cancers, while patients from South-Eastern Europe demonstrated consistently higher rates across all four cancer types. These findings suggest inequitable access to timely investigation, referral and diagnosis across population groups.

Conclusions

ED presentation prior to cancer diagnosis is system-level indicator of diagnostic performance. Observed variation highlights opportunities to strengthen early detection and reduce inequities through precise, coordinated diagnostic pathways. Targeted interventions addressing access to diagnostics, referral processes and culturally responsive care may reduce reliance on emergency pathways and improve outcomes.