Evidence map›Paper›PMID 39373854›Full record

ArticleCJEM2024

Pathways to cancer care after a suspected cancer diagnosis in the emergency department: a survey of emergency physicians across Ontario.

Keerat Grewal, Cameron Thompson, Howard Ovens, Rinku Sutradhar, David W Savage, Bjug Borgundvaag, Sheldon Cheskes, Kerstin de Wit, Antoine Eskander, Jonathan Irish and 5 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in CJEM, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Emergency department use before cancer diagnosis in Ontario, Canada: a population-based study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024
    Article
  4. The emergency department is no place to be told you have cancer.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Keerat GrewalSchwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada. Keerat.grewal@sinaihealth.ca.ORCID 0000-0002-2252-1371
Cameron ThompsonSchwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada.
Howard OvensSchwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada.
Rinku SutradharICES, Toronto, ON, Canada.
David W SavageICES, Toronto, ON, Canada.
Bjug BorgundvaagSchwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada.
Sheldon CheskesDivision of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Kerstin de WitDepartment of Emergency Medicine, Queens University, Kingston, ON, Canada.
Antoine EskanderDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Jonathan IrishDepartment of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
Jacqueline L BenderDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Monika KrzyzanowskaICES, Toronto, ON, Canada.
Rohit MohindraSchwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada.
Venkatesh ThiruganasambandamoorthyDepartment of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
Shelley L McLeodSchwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionLittle is known about how patients are managed after a suspected cancer diagnosis through the emergency department. The objective of this study was to examine the ED management, specifically referral practices, for ten suspected cancer diagnoses by emergency physicians across Ontario and to explore variability in management by cancer-type and centre.

methodsAn electronic survey was distributed to emergency physicians across Ontario, asking about referral practices for patients who could be discharged from the ED with one of ten suspected cancer diagnoses. Options for referral included: in-ED consult, outpatient medical or surgical specialists, surgical or medical oncology, and specialized cancer clinics. Data were described using frequencies and proportions. Variance partition coefficients were calculated to determine variation in responses attributed to differences between hospitals, with physicians nested within hospitals.

results262 physicians from 54 EDs responded. Across most cancers, emergency physicians would refer to surgical specialists for further work-up; however, this ranged from 30.2% for lung cancer to 69.5% for head and neck cancer. For patients with an unknown primary malignancy, most physicians would refer to internal medicine clinic (34.3%) or obtain an in-ED consult (25.0%). Few physicians would refer directly to surgical or medical oncology from the ED. Comments suggest this may be due to oncologists requiring tissue confirmation of malignancy. Most referrals to specialized clinics were for suspected lung (30.2%) or breast cancer (19.5%); however, these appear to only be available at some centres. Variance in referrals between hospitals was lowest for breast cancer (variance partition coefficient = 8.6%) and highest for unknown primary malignancies (variance partition coefficient = 29.8%).

interpretationPhysician management of new suspected cancer varies between EDs and is specific to cancer type. Strategies to standardize access to cancer care in a timely and equitable way for patients with newly suspected cancer in the ED are needed.

Indexed as

Emergency Service, HospitalNeoplasmsReferral and ConsultationCritical PathwaysFemaleHumansMaleOntarioPractice Patterns, Physicians'Surveys and QuestionnairesEmergency medicineOncologyReferralsSurvey

Identifiers

PMID39373854

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.