Diagnosis of Cancer in the Emergency Room - Explaining Persistent Disparities - Diversity Supplement

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. Lung cancer is the deadliest cancer with poor overall survival largely attributed to late

stage at diagnosis and associated comorbidities, particularly among patients with disadvantaged racial and socioeconomic backgrounds. In preliminary analysis of the parent grant, lung cancer was the most common cancer associated with emergency diagnosis, late-stage diagnosis, and comorbidities. Chronic obstructive pulmonary disease (COPD), another

smoking related disease, is a common comorbidity and a competing cause of death among patients with lung cancer. COPD is sometimes complicated by acute exacerbations (AECOPD) that increase disease severity, lung cancer risk and ED visits. However, little is known about the predictors and outcomes of emergency diagnosed lung cancer (EDLC)

among patients with COPD, especially among those of racial minorities and low socioeconomic status. Further, previous population-based studies failed to account for important determinants of lung cancer outcomes such as COPD severity and

smoking. Filling a gap in the scope of the parent grant, the proposed supplement will examine the burden and outcomes of emergency diagnosis of lung cancer (EDLC), as the top emergency diagnosed cancer, with a special emphasis on comorbid COPD, a condition that affects up to 70% of newly diagnosed lung cancer patients and the exacerbation of

which may precipitate emergency lung cancer diagnosis. First, we will quantify the association between EDLC and

COPD, accounting for smoking, severity of COPD, other comorbidities, and frailty, overall and stratified by race/ethnicity

and socioeconomic status (SES). Second, we will quantify healthcare utilization of lung cancer staging and treatment for patients with and without EDLC and whether it varies by COPD status, race/ ethnicity, and SES. Third, we will identify predictors of 1-yr and 3-yr survival after EDLC including patient characteristics and receipt of guideline concordant

treatment. These study aims are nested within the parent grant R01CA264176 using the Surveillance Epidemiology and End Results Data linked to Medicare data (SEER-Medicare) for Medicare beneficiaries who were diagnosed with lung cancer between 2008 and 2017. The diversity candidate, Dr. Eman Metwally, is an African American postdoctoral fellow

with a background in Pulmonary and Critical Care Medicine. Through the proposed supplement, Dr. Metwally will gain

skills in healthcare services research, cancer epidemiology, and professional development. Training and findings obtained

from completion of this supplement will result in scientific publications and presentations, skills required to successfully compete for grant funding, and uniquely position Dr. Metwally to become an independent researcher in lung cancer epidemiology.