BACKGROUND
While some emergency presentations are unavoidable, diagnosis in acute care settings may adversely affect patient experience, engagement with treatment, and long-term survivorship, and has been associated with advanced disease and poorer clinical outcomes.
AIM
To examine the prevalence and lived experience of patients who have received a cancer diagnosis in the ED to identify opportunities to improve patient-centred oncological care.
METHOD
A retrospective cross-sectional study analysed data from a national survey of Australian cancer patients and carers. The forty-question survey explored experiences across the cancer continuum, including diagnosis, treatment and survivorship. Quantitative data were analysed descriptively, while phenomenological analysis of free-text responses identified shared themes within patient and carers’ experiences and unmet supportive care needs.
RESULTS
Of 367 respondents, 19.3% (n = 71) reported receiving their diagnosis in the ED. Among these, 47.9% (n = 34) were diagnosed with a brain or central nervous system malignancy, and 25.4% (n = 18) had metastatic disease at diagnosis. Participants consistently described delayed recognition of symptoms, repeated primary care presentations before emergency admission, and delivery of life-changing news in environments lacking privacy, continuity and emotional support. Diagnoses were frequently communicated by clinicians with no ongoing role in the patient’s cancer care, with limited information provided at discharge and few coordinated referrals to oncology or supportive care services. Participants described significant distress, uncertainty and the burden of independently navigating an unfamiliar healthcare system during the early stages of their cancer journey.
CONCLUSION
Nearly one in five patients received their cancer diagnosis in the ED, highlighting an important gap in patient-centred cancer care. Strengthening early cancer recognition in primary care, implementing structured communication pathways within emergency settings, and ensuring timely access to oncology, cancer care nurse specialists and psychosocial support may improve care transitions and reduce psychosocial distress, and optimise survivorship outcomes from diagnosis.