Questions About Emergency Department Treatment of Patients With Cancer

To the Editor We read with interest the recent article by Rivera et al. We believe that their work merits the following comments and questions. The authors do not specify whether they studied patients who had a progressive "cancer," who were in remission, or who were cancer free. The latter, in whom the diagnosis of cancer was made in the emergency department (ED), were probably included. As recently demonstrated, diagnosis of solid tumors or hematological malignant neoplasms (2 very different things; although these patients are designated as having cancer, they should probably be studied separately) is not rare in the ED. A diagnosis of cancer following an ED presentation is associated with poorer clinical and patient-reported outcomes than those of patients whose cancer is diagnosed after a nonemergency presentation or through a screening program. The inclusion of patients with prostate cancer is debatable and not in agreement with the controversies about its overdiagnosis and treatment, which have been continuing for several years. How would the results have been affected by including only patients with metastatic invasive prostate cancers? The authors suggest that the management of these patients is a dialogue between the oncologist (or hematologist) and the emergency physician.

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