Lung cancer: Significance of place of diagnosis.

Abstract

60 Background: Patients who are diagnosed with lung cancer through emergency department tend to do poorly. We conducted a retrospective study to examine the effect of place of diagnosis on various cancer outcomes including survival, health care cost, and end-of-life (EOL) care. Methods: Patients who died from lung cancer between January 2015 and July 2017 were reviewed. Initial place of diagnosis was determined (Emergency Department/Urgent clinic (ED/UC) or Outpatient). Descriptive statistics, exact Pearson chi-square test, Kaplan-Meier method, and multivariable Cox regression model were used to compare the two groups. Results: 227 patients were included in the analysis. Median age at diagnosis was 65 years. 52% were male; 85% were white. 57% of patients were diagnosed through ED/UC, whereas 43% were diagnosed as part of an outpatient workup. Age, gender, race, and histology (small cell vs. non-small cell) did not vary significantly between the two groups. Rates of palliative care intervention and advance directives were similar. Patients diagnosed through ED/UC were more likely to be metastatic, have symptoms, and not receive any cancer directed therapy. Cost of care was similar between the two groups. Median survival in those who presented to ED/UC was significantly shorter (2.5 vs. 6.5 mo; p<0.001) with a hazard ratio of 1.7 (95% CI:1.3-2.3), even after adjusting for potential confounding factors (age, metastasis, insurance, smoking, treatment). Conclusions: Patients diagnosed with lung cancer through the ED/UC have worse outcomes than those diagnosed as an outpatient. Despite similar cost of care, survival outcomes are worse. This variable remains significant despite controlling for confounders in multivariate analysis.[Table: see text]