A recent study highlights the growing challenges faced by emergency rooms in Canada when dealing with patients who exhibit symptoms of cancer. Many individuals arriving at emergency departments with issues such as abdominal pain or unexplained weight loss are often told, "this may be cancer," and then sent home without clear guidance on when they will receive follow-up care.

The study, which focuses on the experiences of emergency doctors in Ontario, paints a troubling picture of a healthcare system in crisis. Emergency staff often feel overwhelmed, as they are left to manage patients without a clear path for follow-up care. One doctor described the situation as a "gut punch" for patients who are informed, "I don’t know when you’re going to be seen."

Researchers noted that one in five Canadians lacks a regular family doctor, leading to increased reliance on emergency departments for cancer diagnoses. The wait times for tests and specialist appointments can stretch for months, making it increasingly common for patients to receive cancer diagnoses in emergency settings. Once diagnosed, many patients leave without knowing when they will undergo necessary procedures such as scans or biopsies.

Emergency physicians expressed concern that patients without a primary care physician are at risk of being "lost to follow-up." This term refers to situations where referrals are mishandled, such as lost paperwork or incorrect contact information. The study's authors pointed out that patients diagnosed with cancer through emergency departments often face worse outcomes, including higher stages of diagnosis and increased mortality rates.

The lack of established processes for ensuring follow-up care for discharged patients is a significant issue. One doctor emphasized the challenge of managing patients who do not have a family doctor, stating, "I can’t even say, ‘If you don’t hear (about a referral) at least talk to your family physician about this.’"

Emergency departments are increasingly seen as a last resort for patients who cannot access timely care elsewhere. Dr. Keerat Grewal, the study's lead author and an emergency doctor at Mount Sinai Hospital in Toronto, noted that many patients turn to emergency services due to the inability to secure appointments with family doctors or specialists.

Doctors described the referral process as confusing and inconsistent, with frequent refusals from specialists and unclear accountability for patient care. Emergency physicians cannot directly refer patients to oncologists without a tissue biopsy, which requires additional specialists to perform the biopsy and follow up on results.

"The emergency department has become a catch-all, or, some people think, the garbage can of our health-care system," one doctor remarked. This sentiment reflects the frustration felt by emergency staff who are tasked with managing complex cases without adequate support.

Family doctors face similar challenges when trying to refer patients for cancer evaluations. The process often involves multiple steps, including securing a biopsy before a patient can see an oncologist. Grewal pointed out that the emergency department is not structured to handle these referrals effectively.

Earlier research indicated that about one-third of cancer patients in Ontario visited emergency departments within 90 days of their diagnosis, often for symptoms related to their cancer. These patients are more likely to experience poorer outcomes compared to those diagnosed through other means, such as screening.

Emergency doctors often lack a designated person to oversee follow-up investigations, leading to gaps in care. One physician noted, "If the patient misses their biopsy date or if there’s some sort of problem…. I am not set up to track that or take responsibility for that."

The chaotic environment of an emergency room is not conducive to delivering cancer diagnoses. Patients often arrive unprepared for such news, and doctors struggle to provide comprehensive information about prognosis and treatment options.

Grewal highlighted that while lung cancer has a more established diagnostic pathway in Ontario, with special referral clinics for rapid access to specialists, such systems are not universally available.

The study, published in BMJ Open, involved interviews with 20 emergency doctors across six health regions in Ontario. While the findings may not reflect experiences outside the province, Grewal noted that receiving a cancer diagnosis in emergency settings has become increasingly common in Canada. "We’re all seeing this," she stated.