• Keerat Grewal, Cameron Thompson, Howard Ovens, Rinku Sutradhar, David W Savage, Bjug Borgundvaag, Sheldon Cheskes, de WitKerstinKDepartment of Emergency Medicine, Queens University, Kingston, ON, Canada.Department of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada., Antoine Eskander, Jonathan Irish, Jacqueline L Bender, Monika Krzyzanowska, Rohit Mohindra, Venkatesh Thiruganasambandamoorthy, and Shelley L McLeod.
• Schwartz/Reisman Emergency Medicine Institute, Sinai Health, 2B 213-600 University Avenue, Toronto, ON, Canada. Keerat.grewal@sinaihealth.ca.
• CJEM. 2024 Oct 7.

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.© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).

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