Diagnosis of Cancer in the Emergency Room - Explaining Persistent Disparities

项目总结/摘要 癌症是急诊科（艾德）的常见诊断，当患者到达艾德时，他们的 癌症常常发展到晚期。ED不用于诊断癌症。癌症培训 对于艾德医生来说，管理是有限的，并且患者在访问艾德后对后续护理的访问通常是 难其他西方国家的研究告诉我们，与非紧急情况相比， 通过艾德确诊是更差预后的独立预测因子，包括更差的总生存期。 在美国，人们对癌症的紧急诊断知之甚少。从一些研究中 在一些癌症类型中进行的研究，我们知道高达30%的癌症患者被诊断为急诊， 低收入和少数种族/民族患者更有可能受到影响。然而，在 不同的癌症类型，癌症诊断的负担和风险因素作为一个紧急情况还没有得到 研究了此外，在美国没有基于人群的研究比较了患者的生存差异， 在急诊室和其他非急诊室诊断出的癌症。在那些被诊断为 紧急情况下，目前还不清楚为什么他们访问了艾德，而不是去初级保健提供者为他们的 诊断.我们的长期目标是在美国建立紧急癌症诊断的流行病学。 将描述急诊科癌症诊断的负担，包括患者特征 并量化按社会经济地位界定的弱势群体之间的差距， 种族/民族和地理隔离（目标1）。我们将估计艾德的相对重要性（与 非ED）诊断，在控制已知的风险因素如癌症分期，治疗， 患者年龄和慢性疾病（目标2）。最后，我们将调查不同国家之间差异的可修改驱动因素。 通过检查诊断前和诊断后的护理模式， 预防和改善结果的机会（目标3）。我们高效的研究设计使用 流行病学方法分析180万人的高质量、基于人群的SEER-Medicare数据， 被诊断为食道癌、胃癌、结肠/直肠癌、肝癌、胰腺癌、肺癌的美国人， 乳腺、子宫、卵巢、前列腺、膀胱、肾、非霍奇金淋巴瘤、骨髓瘤和白血病。的 调查小组包括癌症流行病学，医疗保健服务，癌症健康差异， 医学社会学，肿瘤学，家庭学，急救医学。这将是第一次大规模的研究， 美国的紧急癌症诊断建立了关于这个重要问题的证据基础， 包括谁受影响，在哪里，为什么，将阐明一个基本上没有认识到的问题，并确定可修改的 最贫困患者的差异驱动因素。

PROJECT SUMMARY/ABSTRACT Cancer is a common diagnosis in the emergency department (ED) and by the time patients reach the ED, their cancer has often progressed to later stages. EDs are not intended to diagnose cancer. Training in cancer management is limited for ED physicians, and patient access to follow-up care after a visit to the ED is often difficult. Research from other western countries tells us that, compared to non-emergency settings, cancer diagnosis through the ED is an independent predictor for worse outcomes, including poorer overall survival. Very little is known about emergency diagnosis of cancer in the United States (U.S.). From a handful of studies conducted in a few cancer types, we know that up to 30% of cancer patients are diagnosed as emergencies, and low income and racial/ethnic minority patients are substantially more likely to be affected. However, across different cancer types, the burden and risk factors of cancer diagnosis as an emergency have not been studied. Furthermore, no population-based studies in the U.S. have compared survival differences in patients with cancers diagnosed in EDs vs other non-emergent settings. And among those who are diagnosed as emergencies, it is unclear why they visited the ED, rather than going to a primary care provider for their diagnosis. Our long term goal is to establish the epidemiology of emergency cancer diagnosis in the U.S. We will describe the burden of cancer diagnosis in the emergency department including the patient characteristics of those most affected and quantify disparities across vulnerable populations defined by socioeconomic status, race/ethnicity, and geographic isolation (Aim 1). We will estimate the relative importance of ED (compared to non-ED) diagnosis on patient survival, after controlling for known risk factors like cancer stage, treatment, patient age and chronic conditions (Aim 2). Finally, we will investigate modifiable drivers of disparities among patients diagnosed as emergencies by examining their pre- and post-diagnostic patterns of care to identify opportunities for prevention and improved outcomes (Aim 3). Our highly efficient study design uses epidemiologic methods to analyze high-quality, population-based SEER-Medicare data for 1.8 million, Americans who were diagnosed cancers of the esophagus, stomach, colon/rectum, liver, pancreas, lung, breast, uterus, ovary, prostate, bladder, kidney, non-Hodgkin’s lymphoma, myeloma, and leukemia. The investigative team includes experts in cancer epidemiology, healthcare delivery, cancer health disparities, medical sociology, and oncology, family, and emergency medicine. This will be the first large-scale study of emergency cancer diagnosis in the U.S. Establishing a base of evidence about this important problem, including who is affected, where, and why, will illuminate a largely unrecognized issue, and identify modifiable drivers of disparities in patients with the poorest prognoses.