Outcomes of patients who receive systemic therapy for metastatic lung cancer after diagnosis via emergency presentation

Barts Health is one of the largest trusts in the UK caring for some its most deprived communities and is one of the best performing trusts for pathological diagnosis. First presentations to the emergency department (ED) with lung cancer are associated with late stage diagnosis and poor outcomes. We sought to understand patients who present to ED as their first presentation of lung cancer. We performed a retrospective review of diagnostics, treatment and overall survival (OS) from time of presentation of new diagnoses of lung cancer in patients who first presented to Barts Health EDs in 2020-21. 97 patients were diagnosed with lung cancer after presenting to ED, of which 84.5% (82/97) presented with metastatic disease. 78% (64/82) of these patients had a biopsy. 40.6% (26/64) of biopsied patients had systemic treatment. Of those biopsied, two cohorts existed; patients who received treatment and those who did not. Within the cohort that received treatment, 80.7% (21/26) had a performance status (PS) of 0-1 and 15.4% (4/26) had a PS 2-4. In the cohort that received no treatment 43.2% (16/37) had a PS 0-1 and 56.8% (21/37) had a PS 2-4. Median OS was 297 days in those who received systemic treatment, whereas the median OS was 55 days in those who did not received treatment. Advances in treatment for metastatic lung cancer has led to better outcomes. Our study demonstrates that despite presenting to ED, 26.8% of patients derive benefit from systemic therapies with a median OS of 297 days. This study supports biopsy in advanced disease but suggests that better identification of patients suitable for treatment is needed prior to biopsy to avoid unnecessary interventions.