Abstract
AIMS: Research on missed opportunities for cancer diagnosis through emergency presentation is limited. We investigated missed opportunities and associated key intervals in cancer patients at a single high-volume academic hospital in Barcelona. METHODS: Two pathways were defined: emergency referral from primary care (PC) and self-referral as emergencies following PC consultations. We used reliable data gathering methods and a rigorous validation procedure through independent reviews. RESULTS: Missed opportunities were identified in 43% of PC-referred patients and 79% of those who self-referred. Patients with missed opportunities were more likely than those without to belong to underserved and ethnic communities. Intervals were invariably longer in patients with missed opportunities and self-referred patients. For pancreatic cancer in emergency referral patients with missed opportunities, the interval between diagnostic clue documentation and workup initiation was 28 (95% CI 24-32) days longer than in those without. For all cancers, the diagnostic interval in emergency referral patients with missed opportunities was 79 (95% CI 75-83) days longer than in those without and, among emergency self-referral patients, it was 119 (95% CI 112-128) days longer. CONCLUSIONS: These findings may guide PC physicians in decision-making, decreasing delays, and suggest opportunities to promote timely help-seeking for underrepresented populations.