Imagine walking into the emergency department (ED) with stomach pain – and leaving with the words: “You may have cancer.” In a crowded, chaotic ED, your bloodwork and imaging may reveal something unexpected. Suddenly, you’re facing a frightening possibility in an environment with little privacy and few immediate answers. You’re sent home to wait for follow-up care that may still be days or weeks away.
This experience has become a common occurrence in Canadian EDs and is the focus of Dr. Keerat Grewal’s work. She’s an emergency physician and a Clinician-Scientist at Sinai Health’s Schwartz/Reisman Emergency Medicine Institute (SREMI) – and one of only a few researchers in Canada looking at ways to improve emergency medicine pathways for patients with suspected cancer.
According to Dr. Grewal’s research, most EDs don’t have processes in place to confirm a cancer diagnosis. “On top of the uncertainties about follow-up care for patients, emergency physicians recognize it’s not the best place for these patients.”
“Being a Clinician-Scientist gives me the opportunity to see firsthand how patients with cancer move through the emergency department and be involved in research to improve care for these patients in the ED and afterwards.”
From uncertainty to coordinated care
Dr. Grewal recently published her findings in the Canadian Medical Association Journal. Her study, titled “Emergency Department Use before Cancer Diagnosis in Ontario, Canada: A Population-Based Study,” was conducted out of SREMI and supported by philanthropy.
In fact, it was a gift from Gerry Schwartz, Heather Reisman and the Gerald Schwartz & Heather Reisman Foundation that founded SREMI – Canada’s only emergency medicine research institute – in 2013. Their commitment and continued partnership have led to new research like that of Dr. Grewal. This year, they made an additional gift of $15 million that will secure the next decade of research and health innovation at SREMI.
Dr. Grewal is grateful for donors, who are enabling her to tackle health challenges in Mount Sinai Hospital’s ED and in EDs across the country. She believes that, with funding, we can begin to rewrite the story for patients with suspected cancer in the ED, so they can be better supported after receiving this information and to help build a system in which clear pathways are developed for patients with suspected cancer.
Currently, Dr. Grewal is adapting a navigation program designed for pregnant patients in the ED, started by SREMI’s Deputy Director Dr. Catherine Varner, to include patients with suspected cancer. It will mean patients with suspected cancer in the ED are connected to a nurse who will help connect them with appropriate resources, ensure questions are answered and navigate their follow-up care.
“We’re so grateful for this program. This program is going to be one of the most systemically impactful resources in Emergency Medicine. Thank you … for doing this.”
“It’s a solution that will mean emergency physicians are comfortable sending a patient home, knowing that someone is there to follow up,” says Dr. Grewal. “And it will ultimately improve the care experience for patients with possible cancer.” And Dr. Grewal’s colleagues agree, calling the navigation program “one of the most systemically impactful resources in Emergency Medicine.”
References:
Grewal, K., etal. (2024). Emergency department use before cancer diagnosis in Ontario,Canada: a population-based study. Canadian Medical Association Journal, 196(37),E1252–E1261. https://doi.org/10.1503/cmaj.240612
