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Cited by 5Emergency and Acute Care StudiesClinical Reasoning and Diagnostic SkillsCancer Diagnosis and Treatment

Time to Diagnosis and Presenting Symptoms of Patients Diagnosed with Cancer Through Emergency and Nonemergency Routes: A Large Retrospective Study From a High-Volume Center

Bosch, Xavier, Mota Gomes, Tiago, Montori-Palacin, Elisabet, Moreno, Pedro, López-Soto, Alfonso·2024·JCO Oncology Practice
DOI 10.1200/op.23.00567
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Abstract

PURPOSE: The symptoms with which a patient with cancer presents and the route taken to diagnosis (emergency v nonemergency) may affect the speed with which the diagnosis of cancer is made, thereby affecting outcomes. We examined time to diagnosis by symptom for cancers diagnosed through emergency and nonemergency routes (NERs). METHODS: We performed a retrospective review of patients diagnosed with 10 solid cancers at Hospital Clínic of Barcelona between March 2013 and June 2023. Cancers were diagnosed through emergency presentation and admission (inpatient emergency route [IER]), emergency presentation and outpatient referral (outpatient emergency route [OER]), and primary care presentation and outpatient referral (NER). We assessed the effect of diagnostic routes on intervals to diagnosis for 19 cancer symptoms. RESULTS: A total of 5,174 and 1,607 patients were diagnosed with cancer through emergency routes and NERs, respectively. Over 85% of patients presenting with alarm (localizing) symptoms such as hematuria through emergency routes were diagnosed with the expected cancer, whereas those with nonlocalizing symptoms such as abdominal pain had a more heterogeneous cancer-site composition. Median intervals were shorter for alarm than nonlocalizing symptoms and tended to be shorter in IERs than OERs. However, for most symptoms, intervals in both routes were invariably shorter than in the NER. For example, diagnostic intervals for hematuria and abdominal pain were 3 and 5 days shorter in IERs than OERs, but they were 5-8 and 17-22 days shorter than in the NER, respectively. CONCLUSION: For patients with alarm symptoms, intervals were shorter than for those with nonlocalizing symptoms and, for most symptoms, intervals were shorter when patients were evaluated by emergency routes rather than NERs.

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  • Patients with site-specific symptoms are more likely to raise the alarm for clinicians regarding urgent referrals.

    “Patients with site-specific symptoms, located in a particular area of the body, are more likely to raise the “alarm” for clinicians regarding urgent referrals [135].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [135]

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Authors
Bosch, X., Mota Gomes, T., Montori-Palacin, E., Moreno, P., & López-Soto, A.
Affiliations
  • Hospital Clínic de Barcelona (ES)
  • Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
ORCID
Venue
JCO Oncology Practice
Publisher
American Society of Clinical Oncology (ASCO)
Published
2024-07
Volume
20
Issue
7
Pages
932-942
ISSN
  • 2688-1527 (ISSN-L)
  • 2688-1535
DOI
10.1200/op.23.00567
OpenAlex
W4392616064
Cited by
5
References
33
Citations by year
2026: 2 · 2025: 2 · 2024: 1
FWCI
2.72
Type
journal article
Language
en
Open access
closed
Locations
  • JCO Oncology Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Oncology › Cancer Diagnosis and Treatment
Keywords
time to diagnosis, cancer symptoms, emergency department presentation, alarm symptoms, hematuria, abdominal pain, solid tumors, delayed diagnosis
MeSH terms
Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Neoplasms, Retrospective Studies, Time Factors

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