Study Finds Many Canadians Visit ER Before Receiving Cancer Diagnosis

Many cancer patients in Canada seek urgent medical care before their diagnosis, with over half being hospitalised following an A&E visit, according to new research.

A study published Monday in the Canadian Medical Association Journal (CMAJ) found that more than a third of cancer patients in Ontario had visited an A&E department within three months prior to their cancer diagnosis.

“This study highlights how often cancer patients are using A&E during the diagnostic phase of their journey,” said Dr Keerat Grewal, study co-author and an emergency medicine physician at Mount Sinai Hospital in Toronto.

“It’s nearly one in three patients who are relying on A&E before their diagnosis, and certain groups of patients are more likely to visit A&E,” she said in an interview.

The study examined over 650,000 patients first diagnosed with cancer in Ontario between 2014 and 2021. Though focused on Ontario, Dr Keerat Grewal noted that this pattern is evident across Canada.

According to findings published in the Canadian Medical Association Journal (CMAJ), of those visiting an A&E department in the 90 days before a cancer diagnosis, 64 per cent visited once, 23 per cent twice, and 13 per cent three or more times, with over half of these patients being hospitalised. The study found that older patients, those living in rural or northern Ontario, and those diagnosed with brain, pancreatic, liver, gallbladder, or thoracic cancers were more likely to visit A&E.

Since the study relied on administrative data, it’s unclear whether the cancer diagnosis itself—which typically requires a biopsy—was confirmed in A&E. Grewal explained, “In A&E, we can’t often say definitively that a patient has cancer, but we frequently have strong suspicions based on bloodwork or imaging.”

Why Do Cancer Patients Visit A&E Before Diagnosis?

There are various reasons patients may visit A&E before a formal cancer diagnosis. For instance, they may present with symptoms linked to undiagnosed cancer, such as coughing up blood, which may later be confirmed as suspected lung cancer. Some patients also arrive for unrelated issues, only for a scan to detect signs of cancer.

Others, who may have received a suspected cancer diagnosis from an outpatient visit—such as with a GP or specialist—might turn to A&E in hopes of speeding up follow-up tests. 

An A&E environment, while not ideal for handling suspected cancer cases, should be able to provide necessary support and access to further services, Grewal emphasised.